|
ECH POR 260BW 15 CAL SZ 18L
|
Facility
|
OP
|
$31,618.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,485.64 |
| Max. Negotiated Rate |
$30,354.06 |
| Rate for Payer: Aetna Commercial |
$24,346.48
|
| Rate for Payer: Anthem Medicaid |
$10,873.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,662.67
|
| Rate for Payer: Cash Price |
$15,809.41
|
| Rate for Payer: Cigna Commercial |
$26,243.61
|
| Rate for Payer: First Health Commercial |
$30,037.87
|
| Rate for Payer: Humana Commercial |
$26,875.99
|
| Rate for Payer: Humana KY Medicaid |
$10,873.71
|
| Rate for Payer: Kentucky WC Medicaid |
$10,984.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,927.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,334.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,485.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,091.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,824.55
|
| Rate for Payer: Ohio Health Group HMO |
$23,714.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,295.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,508.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,816.98
|
| Rate for Payer: PHCS Commercial |
$30,354.06
|
| Rate for Payer: United Healthcare All Payer |
$27,824.55
|
|
|
ECH POR 260BW 15 CAL SZ 18L
|
Facility
|
IP
|
$31,618.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,485.64 |
| Max. Negotiated Rate |
$30,354.06 |
| Rate for Payer: Aetna Commercial |
$24,346.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,662.67
|
| Rate for Payer: Cash Price |
$15,809.41
|
| Rate for Payer: Cigna Commercial |
$26,243.61
|
| Rate for Payer: First Health Commercial |
$30,037.87
|
| Rate for Payer: Humana Commercial |
$26,875.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,927.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,334.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,485.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,824.55
|
| Rate for Payer: Ohio Health Group HMO |
$23,714.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,295.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,508.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,816.98
|
| Rate for Payer: PHCS Commercial |
$30,354.06
|
| Rate for Payer: United Healthcare All Payer |
$27,824.55
|
|
|
ECH POR 260BW 15 CAL SZ 18R
|
Facility
|
OP
|
$31,500.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.26 |
| Max. Negotiated Rate |
$30,240.84 |
| Rate for Payer: Aetna Commercial |
$24,255.68
|
| Rate for Payer: Anthem Medicaid |
$10,833.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,570.69
|
| Rate for Payer: Cash Price |
$15,750.44
|
| Rate for Payer: Cigna Commercial |
$26,145.73
|
| Rate for Payer: First Health Commercial |
$29,925.84
|
| Rate for Payer: Humana Commercial |
$26,775.75
|
| Rate for Payer: Humana KY Medicaid |
$10,833.15
|
| Rate for Payer: Kentucky WC Medicaid |
$10,943.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,830.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,247.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,450.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,050.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,720.77
|
| Rate for Payer: Ohio Health Group HMO |
$23,625.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,200.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,405.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,735.61
|
| Rate for Payer: PHCS Commercial |
$30,240.84
|
| Rate for Payer: United Healthcare All Payer |
$27,720.77
|
|
|
ECH POR 260BW 15 CAL SZ 18R
|
Facility
|
IP
|
$31,500.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.26 |
| Max. Negotiated Rate |
$30,240.84 |
| Rate for Payer: Aetna Commercial |
$24,255.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,570.69
|
| Rate for Payer: Cash Price |
$15,750.44
|
| Rate for Payer: Cigna Commercial |
$26,145.73
|
| Rate for Payer: First Health Commercial |
$29,925.84
|
| Rate for Payer: Humana Commercial |
$26,775.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,830.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,247.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,450.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,720.77
|
| Rate for Payer: Ohio Health Group HMO |
$23,625.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,200.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,405.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,735.61
|
| Rate for Payer: PHCS Commercial |
$30,240.84
|
| Rate for Payer: United Healthcare All Payer |
$27,720.77
|
|
|
ECH POR 260BW 15 CAL SZ 19L
|
Facility
|
IP
|
$31,618.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,485.64 |
| Max. Negotiated Rate |
$30,354.06 |
| Rate for Payer: Aetna Commercial |
$24,346.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,662.67
|
| Rate for Payer: Cash Price |
$15,809.41
|
| Rate for Payer: Cigna Commercial |
$26,243.61
|
| Rate for Payer: First Health Commercial |
$30,037.87
|
| Rate for Payer: Humana Commercial |
$26,875.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,927.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,334.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,485.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,824.55
|
| Rate for Payer: Ohio Health Group HMO |
$23,714.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,295.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,508.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,816.98
|
| Rate for Payer: PHCS Commercial |
$30,354.06
|
| Rate for Payer: United Healthcare All Payer |
$27,824.55
|
|
|
ECH POR 260BW 15 CAL SZ 19L
|
Facility
|
OP
|
$31,618.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,485.64 |
| Max. Negotiated Rate |
$30,354.06 |
| Rate for Payer: Aetna Commercial |
$24,346.48
|
| Rate for Payer: Anthem Medicaid |
$10,873.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,662.67
|
| Rate for Payer: Cash Price |
$15,809.41
|
| Rate for Payer: Cigna Commercial |
$26,243.61
|
| Rate for Payer: First Health Commercial |
$30,037.87
|
| Rate for Payer: Humana Commercial |
$26,875.99
|
| Rate for Payer: Humana KY Medicaid |
$10,873.71
|
| Rate for Payer: Kentucky WC Medicaid |
$10,984.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,927.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,334.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,485.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,091.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,824.55
|
| Rate for Payer: Ohio Health Group HMO |
$23,714.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,295.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,508.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,816.98
|
| Rate for Payer: PHCS Commercial |
$30,354.06
|
| Rate for Payer: United Healthcare All Payer |
$27,824.55
|
|
|
ECH POR 260BW 15 CAL SZ 19R
|
Facility
|
OP
|
$31,500.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.26 |
| Max. Negotiated Rate |
$30,240.84 |
| Rate for Payer: Aetna Commercial |
$24,255.68
|
| Rate for Payer: Anthem Medicaid |
$10,833.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,570.69
|
| Rate for Payer: Cash Price |
$15,750.44
|
| Rate for Payer: Cigna Commercial |
$26,145.73
|
| Rate for Payer: First Health Commercial |
$29,925.84
|
| Rate for Payer: Humana Commercial |
$26,775.75
|
| Rate for Payer: Humana KY Medicaid |
$10,833.15
|
| Rate for Payer: Kentucky WC Medicaid |
$10,943.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,830.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,247.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,450.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,050.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,720.77
|
| Rate for Payer: Ohio Health Group HMO |
$23,625.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,200.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,405.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,735.61
|
| Rate for Payer: PHCS Commercial |
$30,240.84
|
| Rate for Payer: United Healthcare All Payer |
$27,720.77
|
|
|
ECH POR 260BW 15 CAL SZ 19R
|
Facility
|
IP
|
$31,500.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.26 |
| Max. Negotiated Rate |
$30,240.84 |
| Rate for Payer: Aetna Commercial |
$24,255.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,570.69
|
| Rate for Payer: Cash Price |
$15,750.44
|
| Rate for Payer: Cigna Commercial |
$26,145.73
|
| Rate for Payer: First Health Commercial |
$29,925.84
|
| Rate for Payer: Humana Commercial |
$26,775.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,830.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,247.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,450.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,720.77
|
| Rate for Payer: Ohio Health Group HMO |
$23,625.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,200.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,405.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,735.61
|
| Rate for Payer: PHCS Commercial |
$30,240.84
|
| Rate for Payer: United Healthcare All Payer |
$27,720.77
|
|
|
ECH POR 260BW 15 CAL SZ 20L
|
Facility
|
IP
|
$31,500.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.26 |
| Max. Negotiated Rate |
$30,240.84 |
| Rate for Payer: Aetna Commercial |
$24,255.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,570.69
|
| Rate for Payer: Cash Price |
$15,750.44
|
| Rate for Payer: Cigna Commercial |
$26,145.73
|
| Rate for Payer: First Health Commercial |
$29,925.84
|
| Rate for Payer: Humana Commercial |
$26,775.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,830.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,247.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,450.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,720.77
|
| Rate for Payer: Ohio Health Group HMO |
$23,625.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,200.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,405.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,735.61
|
| Rate for Payer: PHCS Commercial |
$30,240.84
|
| Rate for Payer: United Healthcare All Payer |
$27,720.77
|
|
|
ECH POR 260BW 15 CAL SZ 20L
|
Facility
|
OP
|
$31,500.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.26 |
| Max. Negotiated Rate |
$30,240.84 |
| Rate for Payer: Aetna Commercial |
$24,255.68
|
| Rate for Payer: Anthem Medicaid |
$10,833.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,570.69
|
| Rate for Payer: Cash Price |
$15,750.44
|
| Rate for Payer: Cigna Commercial |
$26,145.73
|
| Rate for Payer: First Health Commercial |
$29,925.84
|
| Rate for Payer: Humana Commercial |
$26,775.75
|
| Rate for Payer: Humana KY Medicaid |
$10,833.15
|
| Rate for Payer: Kentucky WC Medicaid |
$10,943.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,830.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,247.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,450.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,050.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,720.77
|
| Rate for Payer: Ohio Health Group HMO |
$23,625.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,200.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,405.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,735.61
|
| Rate for Payer: PHCS Commercial |
$30,240.84
|
| Rate for Payer: United Healthcare All Payer |
$27,720.77
|
|
|
ECH POR 260BW 15 CAL SZ 20R
|
Facility
|
IP
|
$31,500.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.26 |
| Max. Negotiated Rate |
$30,240.84 |
| Rate for Payer: Aetna Commercial |
$24,255.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,570.69
|
| Rate for Payer: Cash Price |
$15,750.44
|
| Rate for Payer: Cigna Commercial |
$26,145.73
|
| Rate for Payer: First Health Commercial |
$29,925.84
|
| Rate for Payer: Humana Commercial |
$26,775.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,830.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,247.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,450.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,720.77
|
| Rate for Payer: Ohio Health Group HMO |
$23,625.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,200.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,405.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,735.61
|
| Rate for Payer: PHCS Commercial |
$30,240.84
|
| Rate for Payer: United Healthcare All Payer |
$27,720.77
|
|
|
ECH POR 260BW 15 CAL SZ 20R
|
Facility
|
OP
|
$31,500.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.26 |
| Max. Negotiated Rate |
$30,240.84 |
| Rate for Payer: Aetna Commercial |
$24,255.68
|
| Rate for Payer: Anthem Medicaid |
$10,833.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,570.69
|
| Rate for Payer: Cash Price |
$15,750.44
|
| Rate for Payer: Cigna Commercial |
$26,145.73
|
| Rate for Payer: First Health Commercial |
$29,925.84
|
| Rate for Payer: Humana Commercial |
$26,775.75
|
| Rate for Payer: Humana KY Medicaid |
$10,833.15
|
| Rate for Payer: Kentucky WC Medicaid |
$10,943.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,830.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,247.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,450.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,050.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,720.77
|
| Rate for Payer: Ohio Health Group HMO |
$23,625.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,200.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,405.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,735.61
|
| Rate for Payer: PHCS Commercial |
$30,240.84
|
| Rate for Payer: United Healthcare All Payer |
$27,720.77
|
|
|
ECH POR 260BW 15 CAL SZ 21L
|
Facility
|
IP
|
$31,500.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.26 |
| Max. Negotiated Rate |
$30,240.84 |
| Rate for Payer: Aetna Commercial |
$24,255.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,570.69
|
| Rate for Payer: Cash Price |
$15,750.44
|
| Rate for Payer: Cigna Commercial |
$26,145.73
|
| Rate for Payer: First Health Commercial |
$29,925.84
|
| Rate for Payer: Humana Commercial |
$26,775.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,830.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,247.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,450.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,720.77
|
| Rate for Payer: Ohio Health Group HMO |
$23,625.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,200.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,405.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,735.61
|
| Rate for Payer: PHCS Commercial |
$30,240.84
|
| Rate for Payer: United Healthcare All Payer |
$27,720.77
|
|
|
ECH POR 260BW 15 CAL SZ 21L
|
Facility
|
OP
|
$31,500.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.26 |
| Max. Negotiated Rate |
$30,240.84 |
| Rate for Payer: Aetna Commercial |
$24,255.68
|
| Rate for Payer: Anthem Medicaid |
$10,833.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,570.69
|
| Rate for Payer: Cash Price |
$15,750.44
|
| Rate for Payer: Cigna Commercial |
$26,145.73
|
| Rate for Payer: First Health Commercial |
$29,925.84
|
| Rate for Payer: Humana Commercial |
$26,775.75
|
| Rate for Payer: Humana KY Medicaid |
$10,833.15
|
| Rate for Payer: Kentucky WC Medicaid |
$10,943.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,830.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,247.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,450.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,050.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,720.77
|
| Rate for Payer: Ohio Health Group HMO |
$23,625.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,200.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,405.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,735.61
|
| Rate for Payer: PHCS Commercial |
$30,240.84
|
| Rate for Payer: United Healthcare All Payer |
$27,720.77
|
|
|
ECH POR 260BW 15 CAL SZ 21R
|
Facility
|
OP
|
$32,524.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,757.22 |
| Max. Negotiated Rate |
$31,223.10 |
| Rate for Payer: Aetna Commercial |
$25,043.53
|
| Rate for Payer: Anthem Medicaid |
$11,185.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,368.77
|
| Rate for Payer: Cash Price |
$16,262.03
|
| Rate for Payer: Cigna Commercial |
$26,994.97
|
| Rate for Payer: First Health Commercial |
$30,897.86
|
| Rate for Payer: Humana Commercial |
$27,645.45
|
| Rate for Payer: Humana KY Medicaid |
$11,185.02
|
| Rate for Payer: Kentucky WC Medicaid |
$11,298.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,669.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,002.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,757.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,409.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,621.17
|
| Rate for Payer: Ohio Health Group HMO |
$24,393.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,019.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,295.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,441.60
|
| Rate for Payer: PHCS Commercial |
$31,223.10
|
| Rate for Payer: United Healthcare All Payer |
$28,621.17
|
|
|
ECH POR 260BW 15 CAL SZ 21R
|
Facility
|
IP
|
$32,524.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,757.22 |
| Max. Negotiated Rate |
$31,223.10 |
| Rate for Payer: Aetna Commercial |
$25,043.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,368.77
|
| Rate for Payer: Cash Price |
$16,262.03
|
| Rate for Payer: Cigna Commercial |
$26,994.97
|
| Rate for Payer: First Health Commercial |
$30,897.86
|
| Rate for Payer: Humana Commercial |
$27,645.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,669.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,002.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,757.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,621.17
|
| Rate for Payer: Ohio Health Group HMO |
$24,393.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,019.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,295.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,441.60
|
| Rate for Payer: PHCS Commercial |
$31,223.10
|
| Rate for Payer: United Healthcare All Payer |
$28,621.17
|
|
|
ECH POR 260BW 15 CAL SZ 22L
|
Facility
|
IP
|
$31,500.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.26 |
| Max. Negotiated Rate |
$30,240.84 |
| Rate for Payer: Aetna Commercial |
$24,255.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,570.69
|
| Rate for Payer: Cash Price |
$15,750.44
|
| Rate for Payer: Cigna Commercial |
$26,145.73
|
| Rate for Payer: First Health Commercial |
$29,925.84
|
| Rate for Payer: Humana Commercial |
$26,775.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,830.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,247.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,450.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,720.77
|
| Rate for Payer: Ohio Health Group HMO |
$23,625.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,200.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,405.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,735.61
|
| Rate for Payer: PHCS Commercial |
$30,240.84
|
| Rate for Payer: United Healthcare All Payer |
$27,720.77
|
|
|
ECH POR 260BW 15 CAL SZ 22L
|
Facility
|
OP
|
$31,500.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,450.26 |
| Max. Negotiated Rate |
$30,240.84 |
| Rate for Payer: Aetna Commercial |
$24,255.68
|
| Rate for Payer: Anthem Medicaid |
$10,833.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,570.69
|
| Rate for Payer: Cash Price |
$15,750.44
|
| Rate for Payer: Cigna Commercial |
$26,145.73
|
| Rate for Payer: First Health Commercial |
$29,925.84
|
| Rate for Payer: Humana Commercial |
$26,775.75
|
| Rate for Payer: Humana KY Medicaid |
$10,833.15
|
| Rate for Payer: Kentucky WC Medicaid |
$10,943.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,830.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,247.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,450.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,050.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,720.77
|
| Rate for Payer: Ohio Health Group HMO |
$23,625.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,200.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,405.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,735.61
|
| Rate for Payer: PHCS Commercial |
$30,240.84
|
| Rate for Payer: United Healthcare All Payer |
$27,720.77
|
|
|
ECH POR 260BW 15 CAL SZ 22R
|
Facility
|
IP
|
$32,524.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,757.22 |
| Max. Negotiated Rate |
$31,223.10 |
| Rate for Payer: Aetna Commercial |
$25,043.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,368.77
|
| Rate for Payer: Cash Price |
$16,262.03
|
| Rate for Payer: Cigna Commercial |
$26,994.97
|
| Rate for Payer: First Health Commercial |
$30,897.86
|
| Rate for Payer: Humana Commercial |
$27,645.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,669.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,002.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,757.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,621.17
|
| Rate for Payer: Ohio Health Group HMO |
$24,393.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,019.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,295.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,441.60
|
| Rate for Payer: PHCS Commercial |
$31,223.10
|
| Rate for Payer: United Healthcare All Payer |
$28,621.17
|
|
|
ECH POR 260BW 15 CAL SZ 22R
|
Facility
|
OP
|
$32,524.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,757.22 |
| Max. Negotiated Rate |
$31,223.10 |
| Rate for Payer: Aetna Commercial |
$25,043.53
|
| Rate for Payer: Anthem Medicaid |
$11,185.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,368.77
|
| Rate for Payer: Cash Price |
$16,262.03
|
| Rate for Payer: Cigna Commercial |
$26,994.97
|
| Rate for Payer: First Health Commercial |
$30,897.86
|
| Rate for Payer: Humana Commercial |
$27,645.45
|
| Rate for Payer: Humana KY Medicaid |
$11,185.02
|
| Rate for Payer: Kentucky WC Medicaid |
$11,298.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,669.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,002.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,757.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,409.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,621.17
|
| Rate for Payer: Ohio Health Group HMO |
$24,393.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,019.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,295.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,441.60
|
| Rate for Payer: PHCS Commercial |
$31,223.10
|
| Rate for Payer: United Healthcare All Payer |
$28,621.17
|
|
|
ECH POR 260BW 30 CAL SZ 12L
|
Facility
|
IP
|
$32,524.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,757.22 |
| Max. Negotiated Rate |
$31,223.10 |
| Rate for Payer: Aetna Commercial |
$25,043.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,368.77
|
| Rate for Payer: Cash Price |
$16,262.03
|
| Rate for Payer: Cigna Commercial |
$26,994.97
|
| Rate for Payer: First Health Commercial |
$30,897.86
|
| Rate for Payer: Humana Commercial |
$27,645.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,669.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,002.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,757.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,621.17
|
| Rate for Payer: Ohio Health Group HMO |
$24,393.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,019.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,295.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,441.60
|
| Rate for Payer: PHCS Commercial |
$31,223.10
|
| Rate for Payer: United Healthcare All Payer |
$28,621.17
|
|
|
ECH POR 260BW 30 CAL SZ 12L
|
Facility
|
OP
|
$32,524.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,757.22 |
| Max. Negotiated Rate |
$31,223.10 |
| Rate for Payer: Aetna Commercial |
$25,043.53
|
| Rate for Payer: Anthem Medicaid |
$11,185.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,368.77
|
| Rate for Payer: Cash Price |
$16,262.03
|
| Rate for Payer: Cigna Commercial |
$26,994.97
|
| Rate for Payer: First Health Commercial |
$30,897.86
|
| Rate for Payer: Humana Commercial |
$27,645.45
|
| Rate for Payer: Humana KY Medicaid |
$11,185.02
|
| Rate for Payer: Kentucky WC Medicaid |
$11,298.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,669.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,002.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,757.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,409.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,621.17
|
| Rate for Payer: Ohio Health Group HMO |
$24,393.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,019.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,295.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,441.60
|
| Rate for Payer: PHCS Commercial |
$31,223.10
|
| Rate for Payer: United Healthcare All Payer |
$28,621.17
|
|
|
ECH POR 260BW 30 CAL SZ 12R
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ECH POR 260BW 30 CAL SZ 12R
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ECH POR 260BW 30 CAL SZ 13L
|
Facility
|
IP
|
$32,524.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,757.22 |
| Max. Negotiated Rate |
$31,223.10 |
| Rate for Payer: Aetna Commercial |
$25,043.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,368.77
|
| Rate for Payer: Cash Price |
$16,262.03
|
| Rate for Payer: Cigna Commercial |
$26,994.97
|
| Rate for Payer: First Health Commercial |
$30,897.86
|
| Rate for Payer: Humana Commercial |
$27,645.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,669.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,002.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,757.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,621.17
|
| Rate for Payer: Ohio Health Group HMO |
$24,393.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,019.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,295.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,441.60
|
| Rate for Payer: PHCS Commercial |
$31,223.10
|
| Rate for Payer: United Healthcare All Payer |
$28,621.17
|
|
