|
TIB ALL-POLY SZ6 14MM LM/RL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 14MM RM/LL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 14MM RM/LL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 8MM LM/RL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 8MM LM/RL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 8MM RM/LL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 8MM RM/LL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB AUG HALF BLOCK #11/10MM
|
Facility
|
IP
|
$5,120.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.65 |
| Max. Negotiated Rate |
$4,915.58 |
| Rate for Payer: Aetna Commercial |
$3,942.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.91
|
| Rate for Payer: Cash Price |
$2,560.20
|
| Rate for Payer: Cigna Commercial |
$4,249.93
|
| Rate for Payer: First Health Commercial |
$4,864.38
|
| Rate for Payer: Humana Commercial |
$4,352.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.32
|
| Rate for Payer: PHCS Commercial |
$4,915.58
|
| Rate for Payer: United Healthcare All Payer |
$4,505.95
|
|
|
TIB AUG HALF BLOCK #11/10MM
|
Facility
|
OP
|
$5,120.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.65 |
| Max. Negotiated Rate |
$4,915.58 |
| Rate for Payer: Aetna Commercial |
$3,942.71
|
| Rate for Payer: Anthem Medicaid |
$1,760.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.91
|
| Rate for Payer: Cash Price |
$2,560.20
|
| Rate for Payer: Cigna Commercial |
$4,249.93
|
| Rate for Payer: First Health Commercial |
$4,864.38
|
| Rate for Payer: Humana Commercial |
$4,352.34
|
| Rate for Payer: Humana KY Medicaid |
$1,760.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.32
|
| Rate for Payer: PHCS Commercial |
$4,915.58
|
| Rate for Payer: United Healthcare All Payer |
$4,505.95
|
|
|
TIB AUG HALF BLOCK #11/5MM
|
Facility
|
OP
|
$5,120.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.65 |
| Max. Negotiated Rate |
$4,915.58 |
| Rate for Payer: Aetna Commercial |
$3,942.71
|
| Rate for Payer: Anthem Medicaid |
$1,760.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.91
|
| Rate for Payer: Cash Price |
$2,560.20
|
| Rate for Payer: Cigna Commercial |
$4,249.93
|
| Rate for Payer: First Health Commercial |
$4,864.38
|
| Rate for Payer: Humana Commercial |
$4,352.34
|
| Rate for Payer: Humana KY Medicaid |
$1,760.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.32
|
| Rate for Payer: PHCS Commercial |
$4,915.58
|
| Rate for Payer: United Healthcare All Payer |
$4,505.95
|
|
|
TIB AUG HALF BLOCK #11/5MM
|
Facility
|
IP
|
$5,120.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.65 |
| Max. Negotiated Rate |
$4,915.58 |
| Rate for Payer: Aetna Commercial |
$3,942.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.91
|
| Rate for Payer: Cash Price |
$2,560.20
|
| Rate for Payer: Cigna Commercial |
$4,249.93
|
| Rate for Payer: First Health Commercial |
$4,864.38
|
| Rate for Payer: Humana Commercial |
$4,352.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.32
|
| Rate for Payer: PHCS Commercial |
$4,915.58
|
| Rate for Payer: United Healthcare All Payer |
$4,505.95
|
|
|
TIB AUG HALF BLOCK #13/10MM
|
Facility
|
OP
|
$5,266.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.58 |
| Max. Negotiated Rate |
$5,055.36 |
| Rate for Payer: Aetna Commercial |
$4,054.82
|
| Rate for Payer: Anthem Medicaid |
$1,810.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,107.48
|
| Rate for Payer: Cash Price |
$2,633.00
|
| Rate for Payer: Cigna Commercial |
$4,370.78
|
| Rate for Payer: First Health Commercial |
$5,002.70
|
| Rate for Payer: Humana Commercial |
$4,476.10
|
| Rate for Payer: Humana KY Medicaid |
$1,810.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,829.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,318.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,886.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,579.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,847.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,634.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,949.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.46
|
| Rate for Payer: PHCS Commercial |
$5,055.36
|
| Rate for Payer: United Healthcare All Payer |
$4,634.08
|
|
|
TIB AUG HALF BLOCK #13/10MM
|
Facility
|
IP
|
$5,266.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.58 |
| Max. Negotiated Rate |
$5,055.36 |
| Rate for Payer: Aetna Commercial |
$4,054.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,107.48
|
| Rate for Payer: Cash Price |
$2,633.00
|
| Rate for Payer: Cigna Commercial |
$4,370.78
|
| Rate for Payer: First Health Commercial |
$5,002.70
|
| Rate for Payer: Humana Commercial |
$4,476.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,318.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,886.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,579.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,634.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,949.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.46
|
| Rate for Payer: PHCS Commercial |
$5,055.36
|
| Rate for Payer: United Healthcare All Payer |
$4,634.08
|
|
|
TIB AUG HALF BLOCK #13/5MM
|
Facility
|
IP
|
$5,266.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.58 |
| Max. Negotiated Rate |
$5,055.36 |
| Rate for Payer: Aetna Commercial |
$4,054.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,107.48
|
| Rate for Payer: Cash Price |
$2,633.00
|
| Rate for Payer: Cigna Commercial |
$4,370.78
|
| Rate for Payer: First Health Commercial |
$5,002.70
|
| Rate for Payer: Humana Commercial |
$4,476.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,318.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,886.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,579.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,634.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,949.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.46
|
| Rate for Payer: PHCS Commercial |
$5,055.36
|
| Rate for Payer: United Healthcare All Payer |
$4,634.08
|
|
|
TIB AUG HALF BLOCK #13/5MM
|
Facility
|
OP
|
$5,266.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.58 |
| Max. Negotiated Rate |
$5,055.36 |
| Rate for Payer: Aetna Commercial |
$4,054.82
|
| Rate for Payer: Anthem Medicaid |
$1,810.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,107.48
|
| Rate for Payer: Cash Price |
$2,633.00
|
| Rate for Payer: Cigna Commercial |
$4,370.78
|
| Rate for Payer: First Health Commercial |
$5,002.70
|
| Rate for Payer: Humana Commercial |
$4,476.10
|
| Rate for Payer: Humana KY Medicaid |
$1,810.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,829.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,318.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,886.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,579.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,847.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,634.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,949.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.46
|
| Rate for Payer: PHCS Commercial |
$5,055.36
|
| Rate for Payer: United Healthcare All Payer |
$4,634.08
|
|
|
TIB AUG HALF BLOCK #3/10MM
|
Facility
|
OP
|
$5,266.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.58 |
| Max. Negotiated Rate |
$5,055.36 |
| Rate for Payer: Aetna Commercial |
$4,054.82
|
| Rate for Payer: Anthem Medicaid |
$1,810.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,107.48
|
| Rate for Payer: Cash Price |
$2,633.00
|
| Rate for Payer: Cigna Commercial |
$4,370.78
|
| Rate for Payer: First Health Commercial |
$5,002.70
|
| Rate for Payer: Humana Commercial |
$4,476.10
|
| Rate for Payer: Humana KY Medicaid |
$1,810.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,829.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,318.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,886.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,579.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,847.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,634.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,949.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.46
|
| Rate for Payer: PHCS Commercial |
$5,055.36
|
| Rate for Payer: United Healthcare All Payer |
$4,634.08
|
|
|
TIB AUG HALF BLOCK #3/10MM
|
Facility
|
IP
|
$5,266.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.58 |
| Max. Negotiated Rate |
$5,055.36 |
| Rate for Payer: Aetna Commercial |
$4,054.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,107.48
|
| Rate for Payer: Cash Price |
$2,633.00
|
| Rate for Payer: Cigna Commercial |
$4,370.78
|
| Rate for Payer: First Health Commercial |
$5,002.70
|
| Rate for Payer: Humana Commercial |
$4,476.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,318.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,886.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,579.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,634.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,949.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.46
|
| Rate for Payer: PHCS Commercial |
$5,055.36
|
| Rate for Payer: United Healthcare All Payer |
$4,634.08
|
|
|
TIB AUG HALF BLOCK #3/5MM
|
Facility
|
OP
|
$5,512.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$716.61 |
| Max. Negotiated Rate |
$5,291.90 |
| Rate for Payer: Aetna Commercial |
$4,244.55
|
| Rate for Payer: Anthem Medicaid |
$1,895.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,299.67
|
| Rate for Payer: Cash Price |
$2,756.20
|
| Rate for Payer: Cigna Commercial |
$4,575.29
|
| Rate for Payer: First Health Commercial |
$5,236.78
|
| Rate for Payer: Humana Commercial |
$4,685.54
|
| Rate for Payer: Humana KY Medicaid |
$1,895.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,915.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,520.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,068.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,653.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,933.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,850.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,134.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,102.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$716.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,708.84
|
| Rate for Payer: PHCS Commercial |
$5,291.90
|
| Rate for Payer: United Healthcare All Payer |
$4,850.91
|
|
|
TIB AUG HALF BLOCK #3/5MM
|
Facility
|
IP
|
$5,512.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$716.61 |
| Max. Negotiated Rate |
$5,291.90 |
| Rate for Payer: Aetna Commercial |
$4,244.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,299.67
|
| Rate for Payer: Cash Price |
$2,756.20
|
| Rate for Payer: Cigna Commercial |
$4,575.29
|
| Rate for Payer: First Health Commercial |
$5,236.78
|
| Rate for Payer: Humana Commercial |
$4,685.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,520.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,068.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,653.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,850.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,134.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,102.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$716.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,708.84
|
| Rate for Payer: PHCS Commercial |
$5,291.90
|
| Rate for Payer: United Healthcare All Payer |
$4,850.91
|
|
|
TIB AUG HALF BLOCK #5/10MM
|
Facility
|
IP
|
$5,120.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.65 |
| Max. Negotiated Rate |
$4,915.58 |
| Rate for Payer: Aetna Commercial |
$3,942.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.91
|
| Rate for Payer: Cash Price |
$2,560.20
|
| Rate for Payer: Cigna Commercial |
$4,249.93
|
| Rate for Payer: First Health Commercial |
$4,864.38
|
| Rate for Payer: Humana Commercial |
$4,352.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.32
|
| Rate for Payer: PHCS Commercial |
$4,915.58
|
| Rate for Payer: United Healthcare All Payer |
$4,505.95
|
|
|
TIB AUG HALF BLOCK #5/10MM
|
Facility
|
OP
|
$5,120.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.65 |
| Max. Negotiated Rate |
$4,915.58 |
| Rate for Payer: Aetna Commercial |
$3,942.71
|
| Rate for Payer: Anthem Medicaid |
$1,760.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.91
|
| Rate for Payer: Cash Price |
$2,560.20
|
| Rate for Payer: Cigna Commercial |
$4,249.93
|
| Rate for Payer: First Health Commercial |
$4,864.38
|
| Rate for Payer: Humana Commercial |
$4,352.34
|
| Rate for Payer: Humana KY Medicaid |
$1,760.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.32
|
| Rate for Payer: PHCS Commercial |
$4,915.58
|
| Rate for Payer: United Healthcare All Payer |
$4,505.95
|
|
|
TIB AUG HALF BLOCK #5/5MM
|
Facility
|
OP
|
$5,352.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.86 |
| Max. Negotiated Rate |
$5,138.69 |
| Rate for Payer: Aetna Commercial |
$4,121.66
|
| Rate for Payer: Anthem Medicaid |
$1,840.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,175.18
|
| Rate for Payer: Cash Price |
$2,676.40
|
| Rate for Payer: Cigna Commercial |
$4,442.82
|
| Rate for Payer: First Health Commercial |
$5,085.16
|
| Rate for Payer: Humana Commercial |
$4,549.88
|
| Rate for Payer: Humana KY Medicaid |
$1,840.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,859.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,389.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,950.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,877.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,710.46
|
| Rate for Payer: Ohio Health Group HMO |
$4,014.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,659.37
|
| Rate for Payer: PHCS Commercial |
$5,138.69
|
| Rate for Payer: United Healthcare All Payer |
$4,710.46
|
|
|
TIB AUG HALF BLOCK #5/5MM
|
Facility
|
IP
|
$5,352.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.86 |
| Max. Negotiated Rate |
$5,138.69 |
| Rate for Payer: Aetna Commercial |
$4,121.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,175.18
|
| Rate for Payer: Cash Price |
$2,676.40
|
| Rate for Payer: Cigna Commercial |
$4,442.82
|
| Rate for Payer: First Health Commercial |
$5,085.16
|
| Rate for Payer: Humana Commercial |
$4,549.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,389.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,950.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,710.46
|
| Rate for Payer: Ohio Health Group HMO |
$4,014.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,659.37
|
| Rate for Payer: PHCS Commercial |
$5,138.69
|
| Rate for Payer: United Healthcare All Payer |
$4,710.46
|
|
|
TIB AUG HALF BLOCK #7/10MM
|
Facility
|
IP
|
$5,120.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.65 |
| Max. Negotiated Rate |
$4,915.58 |
| Rate for Payer: Aetna Commercial |
$3,942.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.91
|
| Rate for Payer: Cash Price |
$2,560.20
|
| Rate for Payer: Cigna Commercial |
$4,249.93
|
| Rate for Payer: First Health Commercial |
$4,864.38
|
| Rate for Payer: Humana Commercial |
$4,352.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.32
|
| Rate for Payer: PHCS Commercial |
$4,915.58
|
| Rate for Payer: United Healthcare All Payer |
$4,505.95
|
|
|
TIB AUG HALF BLOCK #7/10MM
|
Facility
|
OP
|
$5,120.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.65 |
| Max. Negotiated Rate |
$4,915.58 |
| Rate for Payer: Aetna Commercial |
$3,942.71
|
| Rate for Payer: Anthem Medicaid |
$1,760.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.91
|
| Rate for Payer: Cash Price |
$2,560.20
|
| Rate for Payer: Cigna Commercial |
$4,249.93
|
| Rate for Payer: First Health Commercial |
$4,864.38
|
| Rate for Payer: Humana Commercial |
$4,352.34
|
| Rate for Payer: Humana KY Medicaid |
$1,760.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.32
|
| Rate for Payer: PHCS Commercial |
$4,915.58
|
| Rate for Payer: United Healthcare All Payer |
$4,505.95
|
|
