|
ECH POR 260BW 30 CAL SZ 13L
|
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 13R
|
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 13R
|
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 14L
|
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 14L
|
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 14R
|
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 14R
|
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 15L
|
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 15L
|
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 15R
|
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 15R
|
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 16L
|
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 16L
|
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 16R
|
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 16R
|
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 17L
|
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 17L
|
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 17R
|
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 17R
|
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 18L
|
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 18L
|
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 18R
|
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 18R
|
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 19L
|
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 19L
|
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
|
|
