|
ECH POR 190MM STR 15MM CALSZ17
|
Facility
|
IP
|
$30,395.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.43 |
| Max. Negotiated Rate |
$29,179.80 |
| Rate for Payer: Aetna Commercial |
$23,404.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,708.58
|
| Rate for Payer: Cash Price |
$15,197.81
|
| Rate for Payer: Cigna Commercial |
$25,228.36
|
| Rate for Payer: First Health Commercial |
$28,875.84
|
| Rate for Payer: Humana Commercial |
$25,836.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,924.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,431.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,118.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,748.15
|
| Rate for Payer: Ohio Health Group HMO |
$22,796.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,079.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.64
|
| Rate for Payer: PHCS Commercial |
$29,179.80
|
| Rate for Payer: United Healthcare All Payer |
$26,748.15
|
|
|
ECH POR 190MM STR 15MM CALSZ17
|
Facility
|
OP
|
$30,395.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.43 |
| Max. Negotiated Rate |
$29,179.80 |
| Rate for Payer: Aetna Commercial |
$23,404.63
|
| Rate for Payer: Anthem Medicaid |
$10,453.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,708.58
|
| Rate for Payer: Cash Price |
$15,197.81
|
| Rate for Payer: Cigna Commercial |
$25,228.36
|
| Rate for Payer: First Health Commercial |
$28,875.84
|
| Rate for Payer: Humana Commercial |
$25,836.28
|
| Rate for Payer: Humana KY Medicaid |
$10,453.05
|
| Rate for Payer: Kentucky WC Medicaid |
$10,559.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,924.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,431.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,118.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,662.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,748.15
|
| Rate for Payer: Ohio Health Group HMO |
$22,796.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,079.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.64
|
| Rate for Payer: PHCS Commercial |
$29,179.80
|
| Rate for Payer: United Healthcare All Payer |
$26,748.15
|
|
|
ECH POR 190MM STR 15MM CALSZ18
|
Facility
|
IP
|
$30,395.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.43 |
| Max. Negotiated Rate |
$29,179.80 |
| Rate for Payer: Aetna Commercial |
$23,404.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,708.58
|
| Rate for Payer: Cash Price |
$15,197.81
|
| Rate for Payer: Cigna Commercial |
$25,228.36
|
| Rate for Payer: First Health Commercial |
$28,875.84
|
| Rate for Payer: Humana Commercial |
$25,836.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,924.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,431.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,118.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,748.15
|
| Rate for Payer: Ohio Health Group HMO |
$22,796.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,079.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.64
|
| Rate for Payer: PHCS Commercial |
$29,179.80
|
| Rate for Payer: United Healthcare All Payer |
$26,748.15
|
|
|
ECH POR 190MM STR 15MM CALSZ18
|
Facility
|
OP
|
$30,395.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.43 |
| Max. Negotiated Rate |
$29,179.80 |
| Rate for Payer: Aetna Commercial |
$23,404.63
|
| Rate for Payer: Anthem Medicaid |
$10,453.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,708.58
|
| Rate for Payer: Cash Price |
$15,197.81
|
| Rate for Payer: Cigna Commercial |
$25,228.36
|
| Rate for Payer: First Health Commercial |
$28,875.84
|
| Rate for Payer: Humana Commercial |
$25,836.28
|
| Rate for Payer: Humana KY Medicaid |
$10,453.05
|
| Rate for Payer: Kentucky WC Medicaid |
$10,559.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,924.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,431.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,118.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,662.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,748.15
|
| Rate for Payer: Ohio Health Group HMO |
$22,796.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,079.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.64
|
| Rate for Payer: PHCS Commercial |
$29,179.80
|
| Rate for Payer: United Healthcare All Payer |
$26,748.15
|
|
|
ECH POR 190MM STR 15MM CALSZ19
|
Facility
|
IP
|
$30,395.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.43 |
| Max. Negotiated Rate |
$29,179.80 |
| Rate for Payer: Aetna Commercial |
$23,404.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,708.58
|
| Rate for Payer: Cash Price |
$15,197.81
|
| Rate for Payer: Cigna Commercial |
$25,228.36
|
| Rate for Payer: First Health Commercial |
$28,875.84
|
| Rate for Payer: Humana Commercial |
$25,836.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,924.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,431.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,118.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,748.15
|
| Rate for Payer: Ohio Health Group HMO |
$22,796.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,079.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.64
|
| Rate for Payer: PHCS Commercial |
$29,179.80
|
| Rate for Payer: United Healthcare All Payer |
$26,748.15
|
|
|
ECH POR 190MM STR 15MM CALSZ19
|
Facility
|
OP
|
$30,395.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.43 |
| Max. Negotiated Rate |
$29,179.80 |
| Rate for Payer: Aetna Commercial |
$23,404.63
|
| Rate for Payer: Anthem Medicaid |
$10,453.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,708.58
|
| Rate for Payer: Cash Price |
$15,197.81
|
| Rate for Payer: Cigna Commercial |
$25,228.36
|
| Rate for Payer: First Health Commercial |
$28,875.84
|
| Rate for Payer: Humana Commercial |
$25,836.28
|
| Rate for Payer: Humana KY Medicaid |
$10,453.05
|
| Rate for Payer: Kentucky WC Medicaid |
$10,559.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,924.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,431.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,118.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,662.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,748.15
|
| Rate for Payer: Ohio Health Group HMO |
$22,796.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,079.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.64
|
| Rate for Payer: PHCS Commercial |
$29,179.80
|
| Rate for Payer: United Healthcare All Payer |
$26,748.15
|
|
|
ECH POR 190MM STR 15MM CALSZ20
|
Facility
|
IP
|
$30,395.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.43 |
| Max. Negotiated Rate |
$29,179.80 |
| Rate for Payer: Aetna Commercial |
$23,404.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,708.58
|
| Rate for Payer: Cash Price |
$15,197.81
|
| Rate for Payer: Cigna Commercial |
$25,228.36
|
| Rate for Payer: First Health Commercial |
$28,875.84
|
| Rate for Payer: Humana Commercial |
$25,836.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,924.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,431.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,118.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,748.15
|
| Rate for Payer: Ohio Health Group HMO |
$22,796.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,079.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.64
|
| Rate for Payer: PHCS Commercial |
$29,179.80
|
| Rate for Payer: United Healthcare All Payer |
$26,748.15
|
|
|
ECH POR 190MM STR 15MM CALSZ20
|
Facility
|
OP
|
$30,395.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.43 |
| Max. Negotiated Rate |
$29,179.80 |
| Rate for Payer: Aetna Commercial |
$23,404.63
|
| Rate for Payer: Anthem Medicaid |
$10,453.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,708.58
|
| Rate for Payer: Cash Price |
$15,197.81
|
| Rate for Payer: Cigna Commercial |
$25,228.36
|
| Rate for Payer: First Health Commercial |
$28,875.84
|
| Rate for Payer: Humana Commercial |
$25,836.28
|
| Rate for Payer: Humana KY Medicaid |
$10,453.05
|
| Rate for Payer: Kentucky WC Medicaid |
$10,559.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,924.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,431.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,118.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,662.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,748.15
|
| Rate for Payer: Ohio Health Group HMO |
$22,796.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,079.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.64
|
| Rate for Payer: PHCS Commercial |
$29,179.80
|
| Rate for Payer: United Healthcare All Payer |
$26,748.15
|
|
|
ECH POR 190MM STR SZ 11
|
Facility
|
OP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem Medicaid |
$9,602.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Humana KY Medicaid |
$9,602.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,700.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,795.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 11
|
Facility
|
IP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 12
|
Facility
|
IP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 12
|
Facility
|
OP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem Medicaid |
$9,602.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Humana KY Medicaid |
$9,602.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,700.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,795.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 13
|
Facility
|
IP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 13
|
Facility
|
OP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem Medicaid |
$9,602.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Humana KY Medicaid |
$9,602.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,700.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,795.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 14
|
Facility
|
OP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem Medicaid |
$9,602.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Humana KY Medicaid |
$9,602.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,700.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,795.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 14
|
Facility
|
IP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 15
|
Facility
|
OP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem Medicaid |
$9,602.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Humana KY Medicaid |
$9,602.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,700.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,795.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 15
|
Facility
|
IP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 16
|
Facility
|
IP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 16
|
Facility
|
OP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem Medicaid |
$9,602.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Humana KY Medicaid |
$9,602.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,700.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,795.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 17
|
Facility
|
IP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 17
|
Facility
|
OP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem Medicaid |
$9,602.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Humana KY Medicaid |
$9,602.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,700.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,795.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 18
|
Facility
|
IP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 18
|
Facility
|
OP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem Medicaid |
$9,602.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Humana KY Medicaid |
$9,602.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,700.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,795.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
|
ECH POR 190MM STR SZ 19
|
Facility
|
IP
|
$27,922.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,629.98 |
| Max. Negotiated Rate |
$26,806.01 |
| Rate for Payer: Aetna Commercial |
$21,500.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,779.89
|
| Rate for Payer: Cash Price |
$13,961.47
|
| Rate for Payer: Cigna Commercial |
$23,176.03
|
| Rate for Payer: First Health Commercial |
$26,526.78
|
| Rate for Payer: Humana Commercial |
$23,734.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,896.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,607.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,572.18
|
| Rate for Payer: Ohio Health Group HMO |
$20,942.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,584.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,629.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,656.11
|
| Rate for Payer: PHCS Commercial |
$26,806.01
|
| Rate for Payer: United Healthcare All Payer |
$24,572.18
|
|
