|
ECH POR 260BW 30 CAL SZ 19R
|
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 19R
|
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 20L
|
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 20L
|
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 20R
|
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 20R
|
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 21L
|
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 21L
|
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 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 30 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 30 CAL SZ 22L
|
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 22L
|
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 22R
|
Facility
|
OP
|
$32,798.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,839.46 |
| Max. Negotiated Rate |
$31,486.26 |
| Rate for Payer: Aetna Commercial |
$25,254.61
|
| Rate for Payer: Anthem Medicaid |
$11,279.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,582.59
|
| Rate for Payer: Cash Price |
$16,399.09
|
| Rate for Payer: Cigna Commercial |
$27,222.50
|
| Rate for Payer: First Health Commercial |
$31,158.28
|
| Rate for Payer: Humana Commercial |
$27,878.46
|
| Rate for Payer: Humana KY Medicaid |
$11,279.30
|
| Rate for Payer: Kentucky WC Medicaid |
$11,394.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,894.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,205.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,839.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,505.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,862.41
|
| Rate for Payer: Ohio Health Group HMO |
$24,598.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,238.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,534.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,630.75
|
| Rate for Payer: PHCS Commercial |
$31,486.26
|
| Rate for Payer: United Healthcare All Payer |
$28,862.41
|
|
|
ECH POR 260BW 30 CAL SZ 22R
|
Facility
|
IP
|
$32,798.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,839.46 |
| Max. Negotiated Rate |
$31,486.26 |
| Rate for Payer: Aetna Commercial |
$25,254.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,582.59
|
| Rate for Payer: Cash Price |
$16,399.09
|
| Rate for Payer: Cigna Commercial |
$27,222.50
|
| Rate for Payer: First Health Commercial |
$31,158.28
|
| Rate for Payer: Humana Commercial |
$27,878.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,894.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,205.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,839.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,862.41
|
| Rate for Payer: Ohio Health Group HMO |
$24,598.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,238.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,534.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,630.75
|
| Rate for Payer: PHCS Commercial |
$31,486.26
|
| Rate for Payer: United Healthcare All Payer |
$28,862.41
|
|
|
ECH POR STD 260MM BOW SZ 12L
|
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 STD 260MM BOW SZ 12L
|
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 STD 260MM BOW SZ 12R
|
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 STD 260MM BOW SZ 12R
|
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 STD 260MM BOW SZ 13L
|
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 STD 260MM BOW SZ 13L
|
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 STD 260MM BOW SZ 13R
|
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 STD 260MM BOW SZ 13R
|
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 STD 260MM BOW SZ 14L
|
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 STD 260MM BOW SZ 14L
|
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 STD 260MM BOW SZ 14R
|
Facility
|
OP
|
$36,711.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,013.56 |
| Max. Negotiated Rate |
$35,243.40 |
| Rate for Payer: Aetna Commercial |
$28,268.15
|
| Rate for Payer: Anthem Medicaid |
$12,625.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,635.27
|
| Rate for Payer: Cash Price |
$18,355.94
|
| Rate for Payer: Cigna Commercial |
$30,470.86
|
| Rate for Payer: First Health Commercial |
$34,876.29
|
| Rate for Payer: Humana Commercial |
$31,205.10
|
| Rate for Payer: Humana KY Medicaid |
$12,625.22
|
| Rate for Payer: Kentucky WC Medicaid |
$12,753.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,103.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,093.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,013.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,878.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,306.45
|
| Rate for Payer: Ohio Health Group HMO |
$27,533.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,369.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,939.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,331.20
|
| Rate for Payer: PHCS Commercial |
$35,243.40
|
| Rate for Payer: United Healthcare All Payer |
$32,306.45
|
|
