|
ECH POR 190MM STR 15MM CALSZ18
|
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 CALSZ18
|
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 CALSZ19
|
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 CALSZ19
|
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 CALSZ20
|
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 CALSZ20
|
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 SZ 11
|
Facility
|
OP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem Medicaid |
$9,889.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Humana KY Medicaid |
$9,889.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,989.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 11
|
Facility
|
IP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 12
|
Facility
|
OP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem Medicaid |
$9,889.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Humana KY Medicaid |
$9,889.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,989.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 12
|
Facility
|
IP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 13
|
Facility
|
OP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem Medicaid |
$9,889.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Humana KY Medicaid |
$9,889.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,989.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 13
|
Facility
|
IP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 14
|
Facility
|
IP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 14
|
Facility
|
OP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem Medicaid |
$9,889.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Humana KY Medicaid |
$9,889.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,989.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 15
|
Facility
|
IP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 15
|
Facility
|
OP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem Medicaid |
$9,889.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Humana KY Medicaid |
$9,889.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,989.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 16
|
Facility
|
IP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 16
|
Facility
|
OP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem Medicaid |
$9,889.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Humana KY Medicaid |
$9,889.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,989.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 17
|
Facility
|
IP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 17
|
Facility
|
OP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem Medicaid |
$9,889.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Humana KY Medicaid |
$9,889.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,989.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 18
|
Facility
|
IP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 18
|
Facility
|
OP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem Medicaid |
$9,889.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Humana KY Medicaid |
$9,889.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,989.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 19
|
Facility
|
IP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 19
|
Facility
|
OP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem Medicaid |
$9,889.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Humana KY Medicaid |
$9,889.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,989.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
|
ECH POR 190MM STR SZ 20
|
Facility
|
OP
|
$28,756.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.93 |
| Max. Negotiated Rate |
$27,606.18 |
| Rate for Payer: Aetna Commercial |
$22,142.46
|
| Rate for Payer: Anthem Medicaid |
$9,889.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,430.02
|
| Rate for Payer: Cash Price |
$14,378.22
|
| Rate for Payer: Cigna Commercial |
$23,867.85
|
| Rate for Payer: First Health Commercial |
$27,318.62
|
| Rate for Payer: Humana Commercial |
$24,442.97
|
| Rate for Payer: Humana KY Medicaid |
$9,889.34
|
| Rate for Payer: Kentucky WC Medicaid |
$9,989.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,580.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,222.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,626.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,087.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,305.67
|
| Rate for Payer: Ohio Health Group HMO |
$21,567.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,005.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,018.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,841.94
|
| Rate for Payer: PHCS Commercial |
$27,606.18
|
| Rate for Payer: United Healthcare All Payer |
$25,305.67
|
|
