|
ECH POR STD 260MM BOW SZ 20R
|
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 20R
|
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 21L
|
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 21L
|
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 21R
|
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 21R
|
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 22L
|
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 22L
|
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 22R
|
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 22R
|
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 PP HA SZ 11 190MM +15 CAL
|
Facility
|
OP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem Medicaid |
$10,390.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Humana KY Medicaid |
$10,390.11
|
| Rate for Payer: Kentucky WC Medicaid |
$10,495.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,598.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 11 190MM +15 CAL
|
Facility
|
IP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 12 190MM +15 CAL
|
Facility
|
OP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem Medicaid |
$10,390.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Humana KY Medicaid |
$10,390.11
|
| Rate for Payer: Kentucky WC Medicaid |
$10,495.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,598.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 12 190MM +15 CAL
|
Facility
|
IP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 13 190MM +15 CAL
|
Facility
|
OP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem Medicaid |
$10,390.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Humana KY Medicaid |
$10,390.11
|
| Rate for Payer: Kentucky WC Medicaid |
$10,495.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,598.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 13 190MM +15 CAL
|
Facility
|
IP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 14 190MM +15 CAL
|
Facility
|
OP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem Medicaid |
$10,390.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Humana KY Medicaid |
$10,390.11
|
| Rate for Payer: Kentucky WC Medicaid |
$10,495.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,598.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 14 190MM +15 CAL
|
Facility
|
IP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 15 190MM +15 CAL
|
Facility
|
OP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem Medicaid |
$10,390.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Humana KY Medicaid |
$10,390.11
|
| Rate for Payer: Kentucky WC Medicaid |
$10,495.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,598.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 15 190MM +15 CAL
|
Facility
|
IP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 16 190MM +15 CAL
|
Facility
|
IP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 16 190MM +15 CAL
|
Facility
|
OP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem Medicaid |
$10,390.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Humana KY Medicaid |
$10,390.11
|
| Rate for Payer: Kentucky WC Medicaid |
$10,495.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,598.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 17 190MM +15 CAL
|
Facility
|
OP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem Medicaid |
$10,390.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Humana KY Medicaid |
$10,390.11
|
| Rate for Payer: Kentucky WC Medicaid |
$10,495.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,598.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 17 190MM +15 CAL
|
Facility
|
IP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
|
ECH PP HA SZ 18 190MM +15 CAL
|
Facility
|
OP
|
$30,212.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.64 |
| Max. Negotiated Rate |
$29,004.08 |
| Rate for Payer: Aetna Commercial |
$23,263.69
|
| Rate for Payer: Anthem Medicaid |
$10,390.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,565.81
|
| Rate for Payer: Cash Price |
$15,106.29
|
| Rate for Payer: Cigna Commercial |
$25,076.44
|
| Rate for Payer: First Health Commercial |
$28,701.95
|
| Rate for Payer: Humana Commercial |
$25,680.69
|
| Rate for Payer: Humana KY Medicaid |
$10,390.11
|
| Rate for Payer: Kentucky WC Medicaid |
$10,495.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,774.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,296.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,063.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,598.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,587.07
|
| Rate for Payer: Ohio Health Group HMO |
$22,659.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,042.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,927.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.90
|
| Rate for Payer: PHCS Commercial |
$29,004.08
|
| Rate for Payer: United Healthcare All Payer |
$26,587.07
|
|
