|
ECHO MYOCARDIAL STRAIN (P
|
Professional
|
Both
|
$12.06
|
|
|
Service Code
|
HCPCS 93356
|
| Hospital Charge Code |
480P0111
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.67 |
| Rate for Payer: Ambetter Exchange |
$11.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$9.59
|
| Rate for Payer: Anthem Medicaid |
$30.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$11.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$11.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.30
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Humana Medicaid |
$30.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$11.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.67
|
| Rate for Payer: Molina Healthcare Passport |
$30.07
|
| Rate for Payer: Multiplan PHCS |
$7.24
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.40
|
| Rate for Payer: UHCCP Medicaid |
$10.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.08
|
|
|
ECHO MYOCARDIAL STRAIN (T
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 93356
|
| Hospital Charge Code |
480T0111
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.95
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
ECHO MYOCARDIAL STRAIN (T
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 93356
|
| Hospital Charge Code |
480T0111
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$18.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Humana KY Medicaid |
$18.91
|
| Rate for Payer: Kentucky WC Medicaid |
$19.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.95
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 93313
|
| Hospital Charge Code |
48000093
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$709.27 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem Medicaid |
$28.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Humana KY Medicaid |
$28.54
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$28.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.27
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
ECHO TRANSESOPHAGEAL
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 93313
|
| Hospital Charge Code |
48000093
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.74
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.27
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
ECHO TRANSESOPHAGEAL INTRAO(P
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 93318
|
| Hospital Charge Code |
483P0009
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$739.16 |
| Rate for Payer: Aetna Commercial |
$367.08
|
| Rate for Payer: Anthem Medicaid |
$203.83
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$333.03
|
| Rate for Payer: Healthspan PPO |
$739.16
|
| Rate for Payer: Humana Medicaid |
$203.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$154.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.91
|
| Rate for Payer: Molina Healthcare Passport |
$203.83
|
| Rate for Payer: Multiplan PHCS |
$252.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$294.00
|
| Rate for Payer: UHCCP Medicaid |
$147.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.87
|
|
|
ECHO TRANSESOPHAGEAL INTRAOP
|
Professional
|
Both
|
$2,556.00
|
|
|
Service Code
|
HCPCS 93318
|
| Hospital Charge Code |
48300009
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$154.77 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Aetna Commercial |
$367.08
|
| Rate for Payer: Anthem Medicaid |
$203.83
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$333.03
|
| Rate for Payer: Healthspan PPO |
$739.16
|
| Rate for Payer: Humana Medicaid |
$203.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$154.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.91
|
| Rate for Payer: Molina Healthcare Passport |
$203.83
|
| Rate for Payer: Multiplan PHCS |
$1,533.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,789.20
|
| Rate for Payer: UHCCP Medicaid |
$894.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.87
|
|
|
ECHO TRANSESOPHAGEAL INTRAOP
|
Facility
|
OP
|
$2,556.00
|
|
|
Service Code
|
HCPCS 93318
|
| Hospital Charge Code |
48300009
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$2,453.76 |
| Rate for Payer: Aetna Commercial |
$1,968.12
|
| Rate for Payer: Anthem Medicaid |
$879.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,993.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$2,121.48
|
| Rate for Payer: First Health Commercial |
$2,428.20
|
| Rate for Payer: Humana Commercial |
$2,172.60
|
| Rate for Payer: Humana KY Medicaid |
$879.01
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$887.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,095.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,886.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$896.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,249.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,917.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,223.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,763.64
|
| Rate for Payer: PHCS Commercial |
$2,453.76
|
| Rate for Payer: United Healthcare All Payer |
$2,249.28
|
|
|
ECHO TRANSESOPHAGEAL INTRAOP
|
Facility
|
IP
|
$2,556.00
|
|
|
Service Code
|
HCPCS 93318
|
| Hospital Charge Code |
48300009
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$766.80 |
| Max. Negotiated Rate |
$2,453.76 |
| Rate for Payer: Aetna Commercial |
$1,968.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,993.68
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$2,121.48
|
| Rate for Payer: First Health Commercial |
$2,428.20
|
| Rate for Payer: Humana Commercial |
$2,172.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,095.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,886.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$766.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,249.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,917.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,223.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,763.64
|
| Rate for Payer: PHCS Commercial |
$2,453.76
|
| Rate for Payer: United Healthcare All Payer |
$2,249.28
|
|
|
ECHO TRANSESOPHAGEAL INTRAO(T
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS 93318
|
| Hospital Charge Code |
483T0009
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem Medicaid |
$734.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Humana KY Medicaid |
$734.57
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$742.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
ECHO TRANSESOPHAGEAL INTRAO(T
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS 93318
|
| Hospital Charge Code |
483T0009
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
ECH POR 190MM STR 15MM CALSZ11
|
Facility
|
IP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ11
|
Facility
|
OP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem Medicaid |
$10,763.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Humana KY Medicaid |
$10,763.00
|
| Rate for Payer: Kentucky WC Medicaid |
$10,872.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ12
|
Facility
|
IP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ12
|
Facility
|
OP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem Medicaid |
$10,763.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Humana KY Medicaid |
$10,763.00
|
| Rate for Payer: Kentucky WC Medicaid |
$10,872.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ13
|
Facility
|
OP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem Medicaid |
$10,763.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Humana KY Medicaid |
$10,763.00
|
| Rate for Payer: Kentucky WC Medicaid |
$10,872.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ13
|
Facility
|
IP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ14
|
Facility
|
IP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ14
|
Facility
|
OP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem Medicaid |
$10,763.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Humana KY Medicaid |
$10,763.00
|
| Rate for Payer: Kentucky WC Medicaid |
$10,872.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ15
|
Facility
|
IP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ15
|
Facility
|
OP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem Medicaid |
$10,763.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Humana KY Medicaid |
$10,763.00
|
| Rate for Payer: Kentucky WC Medicaid |
$10,872.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ16
|
Facility
|
IP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ16
|
Facility
|
OP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem Medicaid |
$10,763.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Humana KY Medicaid |
$10,763.00
|
| Rate for Payer: Kentucky WC Medicaid |
$10,872.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ17
|
Facility
|
OP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem Medicaid |
$10,763.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Humana KY Medicaid |
$10,763.00
|
| Rate for Payer: Kentucky WC Medicaid |
$10,872.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
|
ECH POR 190MM STR 15MM CALSZ17
|
Facility
|
IP
|
$31,296.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,389.06 |
| Max. Negotiated Rate |
$30,045.00 |
| Rate for Payer: Aetna Commercial |
$24,098.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,411.57
|
| Rate for Payer: Cash Price |
$15,648.44
|
| Rate for Payer: Cigna Commercial |
$25,976.41
|
| Rate for Payer: First Health Commercial |
$29,732.04
|
| Rate for Payer: Humana Commercial |
$26,602.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,663.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,097.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,389.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,541.25
|
| Rate for Payer: Ohio Health Group HMO |
$23,472.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,037.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,228.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,594.85
|
| Rate for Payer: PHCS Commercial |
$30,045.00
|
| Rate for Payer: United Healthcare All Payer |
$27,541.25
|
|
