|
ECH CEM 15MM CAL SZ 14 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 14 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 14 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
|
|
|
ECH CEM 15MM CAL SZ 14 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 16 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 16 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 16 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 16 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
|
|
|
ECH CEM 30MM 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 30MM 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 30MM 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 30MM 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
|
|
|
ECH CEM 30MM CAL SZ 14 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 30MM CAL SZ 14 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 30MM CAL SZ 14 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 30MM CAL SZ 14 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
|
|
|
ECH CEM 30MM CAL SZ 16 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 30MM CAL SZ 16 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 30MM CAL SZ 16 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
|
|
|
ECH CEM 30MM CAL SZ 16 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 FEM CMP BOW SZ12 L 300
|
Facility
|
IP
|
$30,496.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,148.88 |
| Max. Negotiated Rate |
$29,276.40 |
| Rate for Payer: Aetna Commercial |
$23,482.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,787.08
|
| Rate for Payer: Cash Price |
$15,248.12
|
| Rate for Payer: Cigna Commercial |
$25,311.89
|
| Rate for Payer: First Health Commercial |
$28,971.44
|
| Rate for Payer: Humana Commercial |
$25,921.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,006.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,506.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,148.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,836.70
|
| Rate for Payer: Ohio Health Group HMO |
$22,872.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,397.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,042.41
|
| Rate for Payer: PHCS Commercial |
$29,276.40
|
| Rate for Payer: United Healthcare All Payer |
$26,836.70
|
|
|
ECH CEM FEM CMP BOW SZ12 L 300
|
Facility
|
OP
|
$30,496.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,148.88 |
| Max. Negotiated Rate |
$29,276.40 |
| Rate for Payer: Aetna Commercial |
$23,482.11
|
| Rate for Payer: Anthem Medicaid |
$10,487.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,787.08
|
| Rate for Payer: Cash Price |
$15,248.12
|
| Rate for Payer: Cigna Commercial |
$25,311.89
|
| Rate for Payer: First Health Commercial |
$28,971.44
|
| Rate for Payer: Humana Commercial |
$25,921.81
|
| Rate for Payer: Humana KY Medicaid |
$10,487.66
|
| Rate for Payer: Kentucky WC Medicaid |
$10,594.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,006.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,506.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,148.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,698.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,836.70
|
| Rate for Payer: Ohio Health Group HMO |
$22,872.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,397.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,042.41
|
| Rate for Payer: PHCS Commercial |
$29,276.40
|
| Rate for Payer: United Healthcare All Payer |
$26,836.70
|
|
|
ECH CEM FEM CMP BOW SZ12 R 300
|
Facility
|
IP
|
$30,496.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,148.88 |
| Max. Negotiated Rate |
$29,276.40 |
| Rate for Payer: Aetna Commercial |
$23,482.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,787.08
|
| Rate for Payer: Cash Price |
$15,248.12
|
| Rate for Payer: Cigna Commercial |
$25,311.89
|
| Rate for Payer: First Health Commercial |
$28,971.44
|
| Rate for Payer: Humana Commercial |
$25,921.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,006.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,506.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,148.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,836.70
|
| Rate for Payer: Ohio Health Group HMO |
$22,872.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,397.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,042.41
|
| Rate for Payer: PHCS Commercial |
$29,276.40
|
| Rate for Payer: United Healthcare All Payer |
$26,836.70
|
|
|
ECH CEM FEM CMP BOW SZ12 R 300
|
Facility
|
OP
|
$30,496.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,148.88 |
| Max. Negotiated Rate |
$29,276.40 |
| Rate for Payer: Aetna Commercial |
$23,482.11
|
| Rate for Payer: Anthem Medicaid |
$10,487.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,787.08
|
| Rate for Payer: Cash Price |
$15,248.12
|
| Rate for Payer: Cigna Commercial |
$25,311.89
|
| Rate for Payer: First Health Commercial |
$28,971.44
|
| Rate for Payer: Humana Commercial |
$25,921.81
|
| Rate for Payer: Humana KY Medicaid |
$10,487.66
|
| Rate for Payer: Kentucky WC Medicaid |
$10,594.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,006.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,506.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,148.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,698.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,836.70
|
| Rate for Payer: Ohio Health Group HMO |
$22,872.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,397.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,042.41
|
| Rate for Payer: PHCS Commercial |
$29,276.40
|
| Rate for Payer: United Healthcare All Payer |
$26,836.70
|
|
|
ECH CEM FEM CMP BOW SZ14 L 300
|
Facility
|
IP
|
$30,496.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,148.88 |
| Max. Negotiated Rate |
$29,276.40 |
| Rate for Payer: Aetna Commercial |
$23,482.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,787.08
|
| Rate for Payer: Cash Price |
$15,248.12
|
| Rate for Payer: Cigna Commercial |
$25,311.89
|
| Rate for Payer: First Health Commercial |
$28,971.44
|
| Rate for Payer: Humana Commercial |
$25,921.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,006.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,506.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,148.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,836.70
|
| Rate for Payer: Ohio Health Group HMO |
$22,872.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,397.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,042.41
|
| Rate for Payer: PHCS Commercial |
$29,276.40
|
| Rate for Payer: United Healthcare All Payer |
$26,836.70
|
|
