|
ECH POR STD 260MM BOW SZ 21L
|
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 21L
|
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 21R
|
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 21R
|
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 22L
|
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 22L
|
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 22R
|
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 22R
|
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 PP HA SZ 11 190MM +15 CAL
|
Facility
|
IP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 11 190MM +15 CAL
|
Facility
|
OP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem Medicaid |
$10,698.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Humana KY Medicaid |
$10,698.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10,807.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,912.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 12 190MM +15 CAL
|
Facility
|
IP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 12 190MM +15 CAL
|
Facility
|
OP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem Medicaid |
$10,698.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Humana KY Medicaid |
$10,698.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10,807.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,912.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 13 190MM +15 CAL
|
Facility
|
OP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem Medicaid |
$10,698.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Humana KY Medicaid |
$10,698.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10,807.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,912.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 13 190MM +15 CAL
|
Facility
|
IP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 14 190MM +15 CAL
|
Facility
|
OP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem Medicaid |
$10,698.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Humana KY Medicaid |
$10,698.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10,807.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,912.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 14 190MM +15 CAL
|
Facility
|
IP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 15 190MM +15 CAL
|
Facility
|
OP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem Medicaid |
$10,698.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Humana KY Medicaid |
$10,698.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10,807.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,912.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 15 190MM +15 CAL
|
Facility
|
IP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 16 190MM +15 CAL
|
Facility
|
OP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem Medicaid |
$10,698.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Humana KY Medicaid |
$10,698.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10,807.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,912.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 16 190MM +15 CAL
|
Facility
|
IP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 17 190MM +15 CAL
|
Facility
|
OP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem Medicaid |
$10,698.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Humana KY Medicaid |
$10,698.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10,807.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,912.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 17 190MM +15 CAL
|
Facility
|
IP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 18 190MM +15 CAL
|
Facility
|
OP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem Medicaid |
$10,698.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Humana KY Medicaid |
$10,698.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10,807.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,912.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 18 190MM +15 CAL
|
Facility
|
IP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
|
ECH PP HA SZ 19 190MM +15 CAL
|
Facility
|
OP
|
$31,108.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,332.64 |
| Max. Negotiated Rate |
$29,864.46 |
| Rate for Payer: Aetna Commercial |
$23,953.78
|
| Rate for Payer: Anthem Medicaid |
$10,698.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,264.87
|
| Rate for Payer: Cash Price |
$15,554.41
|
| Rate for Payer: Cigna Commercial |
$25,820.31
|
| Rate for Payer: First Health Commercial |
$29,553.37
|
| Rate for Payer: Humana Commercial |
$26,442.49
|
| Rate for Payer: Humana KY Medicaid |
$10,698.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10,807.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,509.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,958.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,332.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,912.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,375.75
|
| Rate for Payer: Ohio Health Group HMO |
$23,331.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,887.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,064.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,465.08
|
| Rate for Payer: PHCS Commercial |
$29,864.46
|
| Rate for Payer: United Healthcare All Payer |
$27,375.75
|
|
