|
ECH POR 260BW 15 CAL SZ 17R
|
Facility
|
OP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem Medicaid |
$10,521.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Humana KY Medicaid |
$10,521.34
|
| Rate for Payer: Kentucky WC Medicaid |
$10,628.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,732.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 17R
|
Facility
|
IP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 18L
|
Facility
|
IP
|
$30,708.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,992.17 |
| Max. Negotiated Rate |
$29,480.62 |
| Rate for Payer: Aetna Commercial |
$23,645.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,953.00
|
| Rate for Payer: Cash Price |
$15,354.49
|
| Rate for Payer: Cigna Commercial |
$25,488.45
|
| Rate for Payer: First Health Commercial |
$29,173.53
|
| Rate for Payer: Humana Commercial |
$26,102.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,181.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,663.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,212.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,023.90
|
| Rate for Payer: Ohio Health Group HMO |
$23,031.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,141.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,992.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,519.78
|
| Rate for Payer: PHCS Commercial |
$29,480.62
|
| Rate for Payer: United Healthcare All Payer |
$27,023.90
|
|
|
ECH POR 260BW 15 CAL SZ 18L
|
Facility
|
OP
|
$30,708.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,992.17 |
| Max. Negotiated Rate |
$29,480.62 |
| Rate for Payer: Aetna Commercial |
$23,645.91
|
| Rate for Payer: Anthem Medicaid |
$10,560.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,953.00
|
| Rate for Payer: Cash Price |
$15,354.49
|
| Rate for Payer: Cigna Commercial |
$25,488.45
|
| Rate for Payer: First Health Commercial |
$29,173.53
|
| Rate for Payer: Humana Commercial |
$26,102.63
|
| Rate for Payer: Humana KY Medicaid |
$10,560.82
|
| Rate for Payer: Kentucky WC Medicaid |
$10,668.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,181.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,663.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,212.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,772.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,023.90
|
| Rate for Payer: Ohio Health Group HMO |
$23,031.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,141.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,992.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,519.78
|
| Rate for Payer: PHCS Commercial |
$29,480.62
|
| Rate for Payer: United Healthcare All Payer |
$27,023.90
|
|
|
ECH POR 260BW 15 CAL SZ 18R
|
Facility
|
OP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem Medicaid |
$10,521.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Humana KY Medicaid |
$10,521.34
|
| Rate for Payer: Kentucky WC Medicaid |
$10,628.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,732.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 18R
|
Facility
|
IP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 19L
|
Facility
|
OP
|
$30,708.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,992.17 |
| Max. Negotiated Rate |
$29,480.62 |
| Rate for Payer: Aetna Commercial |
$23,645.91
|
| Rate for Payer: Anthem Medicaid |
$10,560.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,953.00
|
| Rate for Payer: Cash Price |
$15,354.49
|
| Rate for Payer: Cigna Commercial |
$25,488.45
|
| Rate for Payer: First Health Commercial |
$29,173.53
|
| Rate for Payer: Humana Commercial |
$26,102.63
|
| Rate for Payer: Humana KY Medicaid |
$10,560.82
|
| Rate for Payer: Kentucky WC Medicaid |
$10,668.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,181.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,663.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,212.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,772.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,023.90
|
| Rate for Payer: Ohio Health Group HMO |
$23,031.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,141.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,992.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,519.78
|
| Rate for Payer: PHCS Commercial |
$29,480.62
|
| Rate for Payer: United Healthcare All Payer |
$27,023.90
|
|
|
ECH POR 260BW 15 CAL SZ 19L
|
Facility
|
IP
|
$30,708.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,992.17 |
| Max. Negotiated Rate |
$29,480.62 |
| Rate for Payer: Aetna Commercial |
$23,645.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,953.00
|
| Rate for Payer: Cash Price |
$15,354.49
|
| Rate for Payer: Cigna Commercial |
$25,488.45
|
| Rate for Payer: First Health Commercial |
$29,173.53
|
| Rate for Payer: Humana Commercial |
$26,102.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,181.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,663.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,212.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,023.90
|
| Rate for Payer: Ohio Health Group HMO |
$23,031.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,141.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,992.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,519.78
|
| Rate for Payer: PHCS Commercial |
$29,480.62
|
| Rate for Payer: United Healthcare All Payer |
$27,023.90
|
|
|
ECH POR 260BW 15 CAL SZ 19R
|
Facility
|
IP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 19R
|
Facility
|
OP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem Medicaid |
$10,521.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Humana KY Medicaid |
$10,521.34
|
| Rate for Payer: Kentucky WC Medicaid |
$10,628.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,732.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 20L
|
Facility
|
OP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem Medicaid |
$10,521.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Humana KY Medicaid |
$10,521.34
|
| Rate for Payer: Kentucky WC Medicaid |
$10,628.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,732.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 20L
|
Facility
|
IP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 20R
|
Facility
|
OP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem Medicaid |
$10,521.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Humana KY Medicaid |
$10,521.34
|
| Rate for Payer: Kentucky WC Medicaid |
$10,628.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,732.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 20R
|
Facility
|
IP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 21L
|
Facility
|
OP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem Medicaid |
$10,521.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Humana KY Medicaid |
$10,521.34
|
| Rate for Payer: Kentucky WC Medicaid |
$10,628.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,732.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 21L
|
Facility
|
IP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 21R
|
Facility
|
OP
|
$31,590.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,106.71 |
| Max. Negotiated Rate |
$30,326.49 |
| Rate for Payer: Aetna Commercial |
$24,324.37
|
| Rate for Payer: Anthem Medicaid |
$10,863.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,640.27
|
| Rate for Payer: Cash Price |
$15,795.04
|
| Rate for Payer: Cigna Commercial |
$26,219.77
|
| Rate for Payer: First Health Commercial |
$30,010.59
|
| Rate for Payer: Humana Commercial |
$26,851.58
|
| Rate for Payer: Humana KY Medicaid |
$10,863.83
|
| Rate for Payer: Kentucky WC Medicaid |
$10,974.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,903.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,313.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,477.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,081.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,799.28
|
| Rate for Payer: Ohio Health Group HMO |
$23,692.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,318.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,106.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,792.93
|
| Rate for Payer: PHCS Commercial |
$30,326.49
|
| Rate for Payer: United Healthcare All Payer |
$27,799.28
|
|
|
ECH POR 260BW 15 CAL SZ 21R
|
Facility
|
IP
|
$31,590.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,106.71 |
| Max. Negotiated Rate |
$30,326.49 |
| Rate for Payer: Aetna Commercial |
$24,324.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,640.27
|
| Rate for Payer: Cash Price |
$15,795.04
|
| Rate for Payer: Cigna Commercial |
$26,219.77
|
| Rate for Payer: First Health Commercial |
$30,010.59
|
| Rate for Payer: Humana Commercial |
$26,851.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,903.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,313.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,477.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,799.28
|
| Rate for Payer: Ohio Health Group HMO |
$23,692.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,318.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,106.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,792.93
|
| Rate for Payer: PHCS Commercial |
$30,326.49
|
| Rate for Payer: United Healthcare All Payer |
$27,799.28
|
|
|
ECH POR 260BW 15 CAL SZ 22L
|
Facility
|
IP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 22L
|
Facility
|
OP
|
$30,594.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.24 |
| Max. Negotiated Rate |
$29,370.42 |
| Rate for Payer: Aetna Commercial |
$23,557.53
|
| Rate for Payer: Anthem Medicaid |
$10,521.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,863.47
|
| Rate for Payer: Cash Price |
$15,297.09
|
| Rate for Payer: Cigna Commercial |
$25,393.18
|
| Rate for Payer: First Health Commercial |
$29,064.48
|
| Rate for Payer: Humana Commercial |
$26,005.06
|
| Rate for Payer: Humana KY Medicaid |
$10,521.34
|
| Rate for Payer: Kentucky WC Medicaid |
$10,628.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,087.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,578.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,178.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,732.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,922.89
|
| Rate for Payer: Ohio Health Group HMO |
$22,945.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,977.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,484.20
|
| Rate for Payer: PHCS Commercial |
$29,370.42
|
| Rate for Payer: United Healthcare All Payer |
$26,922.89
|
|
|
ECH POR 260BW 15 CAL SZ 22R
|
Facility
|
OP
|
$31,590.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,106.71 |
| Max. Negotiated Rate |
$30,326.49 |
| Rate for Payer: Aetna Commercial |
$24,324.37
|
| Rate for Payer: Anthem Medicaid |
$10,863.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,640.27
|
| Rate for Payer: Cash Price |
$15,795.04
|
| Rate for Payer: Cigna Commercial |
$26,219.77
|
| Rate for Payer: First Health Commercial |
$30,010.59
|
| Rate for Payer: Humana Commercial |
$26,851.58
|
| Rate for Payer: Humana KY Medicaid |
$10,863.83
|
| Rate for Payer: Kentucky WC Medicaid |
$10,974.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,903.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,313.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,477.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,081.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,799.28
|
| Rate for Payer: Ohio Health Group HMO |
$23,692.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,318.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,106.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,792.93
|
| Rate for Payer: PHCS Commercial |
$30,326.49
|
| Rate for Payer: United Healthcare All Payer |
$27,799.28
|
|
|
ECH POR 260BW 15 CAL SZ 22R
|
Facility
|
IP
|
$31,590.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,106.71 |
| Max. Negotiated Rate |
$30,326.49 |
| Rate for Payer: Aetna Commercial |
$24,324.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,640.27
|
| Rate for Payer: Cash Price |
$15,795.04
|
| Rate for Payer: Cigna Commercial |
$26,219.77
|
| Rate for Payer: First Health Commercial |
$30,010.59
|
| Rate for Payer: Humana Commercial |
$26,851.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,903.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,313.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,477.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,799.28
|
| Rate for Payer: Ohio Health Group HMO |
$23,692.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,318.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,106.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,792.93
|
| Rate for Payer: PHCS Commercial |
$30,326.49
|
| Rate for Payer: United Healthcare All Payer |
$27,799.28
|
|
|
ECH POR 260BW 30 CAL SZ 12L
|
Facility
|
OP
|
$31,590.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,106.71 |
| Max. Negotiated Rate |
$30,326.49 |
| Rate for Payer: Aetna Commercial |
$24,324.37
|
| Rate for Payer: Anthem Medicaid |
$10,863.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,640.27
|
| Rate for Payer: Cash Price |
$15,795.04
|
| Rate for Payer: Cigna Commercial |
$26,219.77
|
| Rate for Payer: First Health Commercial |
$30,010.59
|
| Rate for Payer: Humana Commercial |
$26,851.58
|
| Rate for Payer: Humana KY Medicaid |
$10,863.83
|
| Rate for Payer: Kentucky WC Medicaid |
$10,974.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,903.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,313.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,477.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,081.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,799.28
|
| Rate for Payer: Ohio Health Group HMO |
$23,692.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,318.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,106.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,792.93
|
| Rate for Payer: PHCS Commercial |
$30,326.49
|
| Rate for Payer: United Healthcare All Payer |
$27,799.28
|
|
|
ECH POR 260BW 30 CAL SZ 12L
|
Facility
|
IP
|
$31,590.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,106.71 |
| Max. Negotiated Rate |
$30,326.49 |
| Rate for Payer: Aetna Commercial |
$24,324.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,640.27
|
| Rate for Payer: Cash Price |
$15,795.04
|
| Rate for Payer: Cigna Commercial |
$26,219.77
|
| Rate for Payer: First Health Commercial |
$30,010.59
|
| Rate for Payer: Humana Commercial |
$26,851.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,903.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,313.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,477.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,799.28
|
| Rate for Payer: Ohio Health Group HMO |
$23,692.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,318.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,106.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,792.93
|
| Rate for Payer: PHCS Commercial |
$30,326.49
|
| Rate for Payer: United Healthcare All Payer |
$27,799.28
|
|
|
ECH POR 260BW 30 CAL SZ 12R
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
