|
ECH POR 260BW 30 CAL SZ 19L
|
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 19L
|
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 19R
|
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 19R
|
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 20L
|
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 20L
|
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 20R
|
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 20R
|
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 21L
|
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 21L
|
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 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 30 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 30 CAL SZ 22L
|
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: Anthem Medicaid |
$10,863.83
|
| 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: 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 22L
|
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 22R
|
Facility
|
IP
|
$31,856.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,141.40 |
| Max. Negotiated Rate |
$30,582.62 |
| Rate for Payer: Aetna Commercial |
$24,529.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,848.38
|
| Rate for Payer: Cash Price |
$15,928.45
|
| Rate for Payer: Cigna Commercial |
$26,441.23
|
| Rate for Payer: First Health Commercial |
$30,264.06
|
| Rate for Payer: Humana Commercial |
$27,078.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,122.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,510.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,557.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,034.07
|
| Rate for Payer: Ohio Health Group HMO |
$23,892.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,875.64
|
| Rate for Payer: PHCS Commercial |
$30,582.62
|
| Rate for Payer: United Healthcare All Payer |
$28,034.07
|
|
|
ECH POR 260BW 30 CAL SZ 22R
|
Facility
|
OP
|
$31,856.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,141.40 |
| Max. Negotiated Rate |
$30,582.62 |
| Rate for Payer: Aetna Commercial |
$24,529.81
|
| Rate for Payer: Anthem Medicaid |
$10,955.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,848.38
|
| Rate for Payer: Cash Price |
$15,928.45
|
| Rate for Payer: Cigna Commercial |
$26,441.23
|
| Rate for Payer: First Health Commercial |
$30,264.06
|
| Rate for Payer: Humana Commercial |
$27,078.36
|
| Rate for Payer: Humana KY Medicaid |
$10,955.59
|
| Rate for Payer: Kentucky WC Medicaid |
$11,067.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,122.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,510.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,557.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,034.07
|
| Rate for Payer: Ohio Health Group HMO |
$23,892.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,875.64
|
| Rate for Payer: PHCS Commercial |
$30,582.62
|
| Rate for Payer: United Healthcare All Payer |
$28,034.07
|
|
|
ECH POR STD 260MM BOW SZ 12L
|
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 STD 260MM BOW SZ 12L
|
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 STD 260MM BOW SZ 12R
|
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 STD 260MM BOW SZ 12R
|
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 STD 260MM BOW SZ 13L
|
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 STD 260MM BOW SZ 13L
|
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 STD 260MM BOW SZ 13R
|
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 STD 260MM BOW SZ 13R
|
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 STD 260MM BOW SZ 14L
|
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
|
|
