|
ECG W/12 LEADS - TRACING ONLY
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS G0404
|
| Hospital Charge Code |
73000002
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
ECH 190MM+15 STR SZ 11 CALCAR
|
Facility
|
IP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM+15 STR SZ 11 CALCAR
|
Facility
|
OP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem Medicaid |
$11,803.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Humana KY Medicaid |
$11,803.72
|
| Rate for Payer: Kentucky WC Medicaid |
$11,923.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,040.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM+15 STR SZ 12 CALCAR
|
Facility
|
OP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem Medicaid |
$11,803.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Humana KY Medicaid |
$11,803.72
|
| Rate for Payer: Kentucky WC Medicaid |
$11,923.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,040.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM+15 STR SZ 12 CALCAR
|
Facility
|
IP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STD SZ 20 COLLAR
|
Facility
|
IP
|
$37,260.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,178.09 |
| Max. Negotiated Rate |
$35,769.90 |
| Rate for Payer: Aetna Commercial |
$28,690.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,063.04
|
| Rate for Payer: Cash Price |
$18,630.16
|
| Rate for Payer: Cigna Commercial |
$30,926.06
|
| Rate for Payer: First Health Commercial |
$35,397.29
|
| Rate for Payer: Humana Commercial |
$31,671.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,553.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,498.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,178.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,789.07
|
| Rate for Payer: Ohio Health Group HMO |
$27,945.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,808.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,416.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,709.61
|
| Rate for Payer: PHCS Commercial |
$35,769.90
|
| Rate for Payer: United Healthcare All Payer |
$32,789.07
|
|
|
ECH 190MM STD SZ 20 COLLAR
|
Facility
|
OP
|
$37,260.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,178.09 |
| Max. Negotiated Rate |
$35,769.90 |
| Rate for Payer: Aetna Commercial |
$28,690.44
|
| Rate for Payer: Anthem Medicaid |
$12,813.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,063.04
|
| Rate for Payer: Cash Price |
$18,630.16
|
| Rate for Payer: Cigna Commercial |
$30,926.06
|
| Rate for Payer: First Health Commercial |
$35,397.29
|
| Rate for Payer: Humana Commercial |
$31,671.26
|
| Rate for Payer: Humana KY Medicaid |
$12,813.82
|
| Rate for Payer: Kentucky WC Medicaid |
$12,944.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,553.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,498.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,178.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,070.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,789.07
|
| Rate for Payer: Ohio Health Group HMO |
$27,945.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,808.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,416.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,709.61
|
| Rate for Payer: PHCS Commercial |
$35,769.90
|
| Rate for Payer: United Healthcare All Payer |
$32,789.07
|
|
|
ECH 190MM STR SZ 13 COLLAR
|
Facility
|
IP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STR SZ 13 COLLAR
|
Facility
|
OP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem Medicaid |
$11,803.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Humana KY Medicaid |
$11,803.72
|
| Rate for Payer: Kentucky WC Medicaid |
$11,923.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,040.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STR SZ 14 COLLAR
|
Facility
|
OP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem Medicaid |
$11,803.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Humana KY Medicaid |
$11,803.72
|
| Rate for Payer: Kentucky WC Medicaid |
$11,923.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,040.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STR SZ 14 COLLAR
|
Facility
|
IP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STR SZ 15 COLLAR
|
Facility
|
OP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem Medicaid |
$11,803.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Humana KY Medicaid |
$11,803.72
|
| Rate for Payer: Kentucky WC Medicaid |
$11,923.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,040.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STR SZ 15 COLLAR
|
Facility
|
IP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STR SZ 16 COLLAR
|
Facility
|
OP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem Medicaid |
$11,803.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Humana KY Medicaid |
$11,803.72
|
| Rate for Payer: Kentucky WC Medicaid |
$11,923.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,040.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STR SZ 16 COLLAR
|
Facility
|
IP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STR SZ 17 COLLAR
|
Facility
|
OP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem Medicaid |
$11,803.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Humana KY Medicaid |
$11,803.72
|
| Rate for Payer: Kentucky WC Medicaid |
$11,923.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,040.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STR SZ 17 COLLAR
|
Facility
|
IP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STR SZ 18 COLLAR
|
Facility
|
OP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem Medicaid |
$11,803.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Humana KY Medicaid |
$11,803.72
|
| Rate for Payer: Kentucky WC Medicaid |
$11,923.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,040.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STR SZ 18 COLLAR
|
Facility
|
IP
|
$34,323.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,296.94 |
| Max. Negotiated Rate |
$32,950.20 |
| Rate for Payer: Aetna Commercial |
$26,428.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,772.03
|
| Rate for Payer: Cash Price |
$17,161.56
|
| Rate for Payer: Cigna Commercial |
$28,488.19
|
| Rate for Payer: First Health Commercial |
$32,606.96
|
| Rate for Payer: Humana Commercial |
$29,174.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,144.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,296.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,204.35
|
| Rate for Payer: Ohio Health Group HMO |
$25,742.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,458.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,861.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,682.95
|
| Rate for Payer: PHCS Commercial |
$32,950.20
|
| Rate for Payer: United Healthcare All Payer |
$30,204.35
|
|
|
ECH 190MM STR SZ 19 COLLAR
|
Facility
|
IP
|
$37,260.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,178.09 |
| Max. Negotiated Rate |
$35,769.90 |
| Rate for Payer: Aetna Commercial |
$28,690.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,063.04
|
| Rate for Payer: Cash Price |
$18,630.16
|
| Rate for Payer: Cigna Commercial |
$30,926.06
|
| Rate for Payer: First Health Commercial |
$35,397.29
|
| Rate for Payer: Humana Commercial |
$31,671.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,553.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,498.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,178.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,789.07
|
| Rate for Payer: Ohio Health Group HMO |
$27,945.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,808.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,416.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,709.61
|
| Rate for Payer: PHCS Commercial |
$35,769.90
|
| Rate for Payer: United Healthcare All Payer |
$32,789.07
|
|
|
ECH 190MM STR SZ 19 COLLAR
|
Facility
|
OP
|
$37,260.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,178.09 |
| Max. Negotiated Rate |
$35,769.90 |
| Rate for Payer: Aetna Commercial |
$28,690.44
|
| Rate for Payer: Anthem Medicaid |
$12,813.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,063.04
|
| Rate for Payer: Cash Price |
$18,630.16
|
| Rate for Payer: Cigna Commercial |
$30,926.06
|
| Rate for Payer: First Health Commercial |
$35,397.29
|
| Rate for Payer: Humana Commercial |
$31,671.26
|
| Rate for Payer: Humana KY Medicaid |
$12,813.82
|
| Rate for Payer: Kentucky WC Medicaid |
$12,944.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,553.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,498.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,178.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,070.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,789.07
|
| Rate for Payer: Ohio Health Group HMO |
$27,945.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,808.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,416.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,709.61
|
| Rate for Payer: PHCS Commercial |
$35,769.90
|
| Rate for Payer: United Healthcare All Payer |
$32,789.07
|
|
|
ECH CEM 15MM CAL SZ 12 175MM
|
Facility
|
OP
|
$27,698.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,309.46 |
| Max. Negotiated Rate |
$26,590.26 |
| Rate for Payer: Aetna Commercial |
$21,327.61
|
| Rate for Payer: Anthem Medicaid |
$9,525.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,604.59
|
| Rate for Payer: Cash Price |
$13,849.09
|
| Rate for Payer: Cigna Commercial |
$22,989.50
|
| Rate for Payer: First Health Commercial |
$26,313.28
|
| Rate for Payer: Humana Commercial |
$23,543.46
|
| Rate for Payer: Humana KY Medicaid |
$9,525.41
|
| Rate for Payer: Kentucky WC Medicaid |
$9,622.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,712.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,441.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,309.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,716.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,374.41
|
| Rate for Payer: Ohio Health Group HMO |
$20,773.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,097.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,111.75
|
| Rate for Payer: PHCS Commercial |
$26,590.26
|
| Rate for Payer: United Healthcare All Payer |
$24,374.41
|
|
|
ECH CEM 15MM CAL SZ 12 175MM
|
Facility
|
IP
|
$27,698.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,309.46 |
| Max. Negotiated Rate |
$26,590.26 |
| Rate for Payer: Aetna Commercial |
$21,327.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,604.59
|
| Rate for Payer: Cash Price |
$13,849.09
|
| Rate for Payer: Cigna Commercial |
$22,989.50
|
| Rate for Payer: First Health Commercial |
$26,313.28
|
| Rate for Payer: Humana Commercial |
$23,543.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,712.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,441.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,309.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,374.41
|
| Rate for Payer: Ohio Health Group HMO |
$20,773.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,097.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,111.75
|
| Rate for Payer: PHCS Commercial |
$26,590.26
|
| Rate for Payer: United Healthcare All Payer |
$24,374.41
|
|
|
ECH CEM 15MM CAL SZ 12 225MM
|
Facility
|
OP
|
$27,698.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,309.46 |
| Max. Negotiated Rate |
$26,590.26 |
| Rate for Payer: Aetna Commercial |
$21,327.61
|
| Rate for Payer: Anthem Medicaid |
$9,525.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,604.59
|
| Rate for Payer: Cash Price |
$13,849.09
|
| Rate for Payer: Cigna Commercial |
$22,989.50
|
| Rate for Payer: First Health Commercial |
$26,313.28
|
| Rate for Payer: Humana Commercial |
$23,543.46
|
| Rate for Payer: Humana KY Medicaid |
$9,525.41
|
| Rate for Payer: Kentucky WC Medicaid |
$9,622.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,712.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,441.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,309.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,716.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,374.41
|
| Rate for Payer: Ohio Health Group HMO |
$20,773.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,097.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,111.75
|
| Rate for Payer: PHCS Commercial |
$26,590.26
|
| Rate for Payer: United Healthcare All Payer |
$24,374.41
|
|
|
ECH CEM 15MM CAL SZ 12 225MM
|
Facility
|
IP
|
$27,698.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,309.46 |
| Max. Negotiated Rate |
$26,590.26 |
| Rate for Payer: Aetna Commercial |
$21,327.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,604.59
|
| Rate for Payer: Cash Price |
$13,849.09
|
| Rate for Payer: Cigna Commercial |
$22,989.50
|
| Rate for Payer: First Health Commercial |
$26,313.28
|
| Rate for Payer: Humana Commercial |
$23,543.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,712.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,441.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,309.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,374.41
|
| Rate for Payer: Ohio Health Group HMO |
$20,773.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,097.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,111.75
|
| Rate for Payer: PHCS Commercial |
$26,590.26
|
| Rate for Payer: United Healthcare All Payer |
$24,374.41
|
|
