|
ECHELON PP HA SZ 12 190MM
|
Facility
|
IP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 12 190MM
|
Facility
|
OP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem Medicaid |
$10,393.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Humana KY Medicaid |
$10,393.58
|
| Rate for Payer: Kentucky WC Medicaid |
$10,499.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,602.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 13 190MM
|
Facility
|
OP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem Medicaid |
$10,393.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Humana KY Medicaid |
$10,393.58
|
| Rate for Payer: Kentucky WC Medicaid |
$10,499.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,602.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 13 190MM
|
Facility
|
IP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 14 190MM
|
Facility
|
OP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem Medicaid |
$10,393.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Humana KY Medicaid |
$10,393.58
|
| Rate for Payer: Kentucky WC Medicaid |
$10,499.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,602.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 14 190MM
|
Facility
|
IP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 15 190MM
|
Facility
|
OP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem Medicaid |
$10,393.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Humana KY Medicaid |
$10,393.58
|
| Rate for Payer: Kentucky WC Medicaid |
$10,499.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,602.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 15 190MM
|
Facility
|
IP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 16 190MM
|
Facility
|
IP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 16 190MM
|
Facility
|
OP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem Medicaid |
$10,393.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Humana KY Medicaid |
$10,393.58
|
| Rate for Payer: Kentucky WC Medicaid |
$10,499.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,602.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 17 190MM
|
Facility
|
IP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 17 190MM
|
Facility
|
OP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem Medicaid |
$10,393.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Humana KY Medicaid |
$10,393.58
|
| Rate for Payer: Kentucky WC Medicaid |
$10,499.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,602.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 18 190MM
|
Facility
|
OP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem Medicaid |
$10,393.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Humana KY Medicaid |
$10,393.58
|
| Rate for Payer: Kentucky WC Medicaid |
$10,499.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,602.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 18 190MM
|
Facility
|
IP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 19 190MM
|
Facility
|
OP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem Medicaid |
$10,393.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Humana KY Medicaid |
$10,393.58
|
| Rate for Payer: Kentucky WC Medicaid |
$10,499.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,602.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 19 190MM
|
Facility
|
IP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 20 190MM
|
Facility
|
OP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem Medicaid |
$10,393.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Humana KY Medicaid |
$10,393.58
|
| Rate for Payer: Kentucky WC Medicaid |
$10,499.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,602.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON PP HA SZ 20 190MM
|
Facility
|
IP
|
$30,222.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,066.81 |
| Max. Negotiated Rate |
$29,013.78 |
| Rate for Payer: Aetna Commercial |
$23,271.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,573.70
|
| Rate for Payer: Cash Price |
$15,111.34
|
| Rate for Payer: Cigna Commercial |
$25,084.83
|
| Rate for Payer: First Health Commercial |
$28,711.56
|
| Rate for Payer: Humana Commercial |
$25,689.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,782.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,304.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,066.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,595.97
|
| Rate for Payer: Ohio Health Group HMO |
$22,667.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,178.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,293.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,853.66
|
| Rate for Payer: PHCS Commercial |
$29,013.78
|
| Rate for Payer: United Healthcare All Payer |
$26,595.97
|
|
|
ECHELON THIN SHAFT REAMER 23MM
|
Facility
|
IP
|
$4,425.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,327.71 |
| Max. Negotiated Rate |
$4,248.66 |
| Rate for Payer: Aetna Commercial |
$3,407.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,452.04
|
| Rate for Payer: Cash Price |
$2,212.84
|
| Rate for Payer: Cigna Commercial |
$3,673.32
|
| Rate for Payer: First Health Commercial |
$4,204.41
|
| Rate for Payer: Humana Commercial |
$3,761.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,629.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,266.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,327.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,894.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,319.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,540.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,850.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,053.73
|
| Rate for Payer: PHCS Commercial |
$4,248.66
|
| Rate for Payer: United Healthcare All Payer |
$3,894.61
|
|
|
ECHELON THIN SHAFT REAMER 23MM
|
Facility
|
OP
|
$4,425.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,327.71 |
| Max. Negotiated Rate |
$4,248.66 |
| Rate for Payer: Aetna Commercial |
$3,407.78
|
| Rate for Payer: Anthem Medicaid |
$1,521.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,452.04
|
| Rate for Payer: Cash Price |
$2,212.84
|
| Rate for Payer: Cigna Commercial |
$3,673.32
|
| Rate for Payer: First Health Commercial |
$4,204.41
|
| Rate for Payer: Humana Commercial |
$3,761.84
|
| Rate for Payer: Humana KY Medicaid |
$1,521.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,537.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,629.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,266.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,327.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,552.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,894.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,319.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,540.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,850.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,053.73
|
| Rate for Payer: PHCS Commercial |
$4,248.66
|
| Rate for Payer: United Healthcare All Payer |
$3,894.61
|
|
|
ECHELON THIN SHAFT REAMER 24MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ECHELON THIN SHAFT REAMER 24MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ECHELON THN SHFT REAMER 22.5MM
|
Facility
|
OP
|
$4,425.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,327.71 |
| Max. Negotiated Rate |
$4,248.66 |
| Rate for Payer: Aetna Commercial |
$3,407.78
|
| Rate for Payer: Anthem Medicaid |
$1,521.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,452.04
|
| Rate for Payer: Cash Price |
$2,212.84
|
| Rate for Payer: Cigna Commercial |
$3,673.32
|
| Rate for Payer: First Health Commercial |
$4,204.41
|
| Rate for Payer: Humana Commercial |
$3,761.84
|
| Rate for Payer: Humana KY Medicaid |
$1,521.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,537.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,629.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,266.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,327.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,552.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,894.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,319.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,540.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,850.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,053.73
|
| Rate for Payer: PHCS Commercial |
$4,248.66
|
| Rate for Payer: United Healthcare All Payer |
$3,894.61
|
|
|
ECHELON THN SHFT REAMER 22.5MM
|
Facility
|
IP
|
$4,425.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,327.71 |
| Max. Negotiated Rate |
$4,248.66 |
| Rate for Payer: Aetna Commercial |
$3,407.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,452.04
|
| Rate for Payer: Cash Price |
$2,212.84
|
| Rate for Payer: Cigna Commercial |
$3,673.32
|
| Rate for Payer: First Health Commercial |
$4,204.41
|
| Rate for Payer: Humana Commercial |
$3,761.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,629.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,266.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,327.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,894.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,319.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,540.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,850.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,053.73
|
| Rate for Payer: PHCS Commercial |
$4,248.66
|
| Rate for Payer: United Healthcare All Payer |
$3,894.61
|
|
|
ECHO 2D W/COL/DOP W W/WO CON(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
483P0010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$432.84 |
| Rate for Payer: Aetna Commercial |
$429.58
|
| Rate for Payer: Ambetter Exchange |
$175.69
|
| Rate for Payer: Anthem Medicaid |
$220.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$210.83
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$432.84
|
| Rate for Payer: Healthspan PPO |
$403.80
|
| Rate for Payer: Humana Medicaid |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.55
|
| Rate for Payer: Molina Healthcare Passport |
$220.15
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.40
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: United Healthcare Non-Options |
$281.77
|
| Rate for Payer: United Healthcare Options |
$230.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.69
|
|
