|
TIB AUG HALF BLOCK #9/10MM
|
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 #9/10MM
|
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 #9/5MM
|
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 #9/5MM
|
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 BASE JRNY W/O TAPE NP 2 LT
|
Facility
|
OP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem Medicaid |
$4,227.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Humana KY Medicaid |
$4,227.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 2 LT
|
Facility
|
IP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 2 RT
|
Facility
|
OP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem Medicaid |
$4,227.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Humana KY Medicaid |
$4,227.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 2 RT
|
Facility
|
IP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 3 LT
|
Facility
|
IP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 3 LT
|
Facility
|
OP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem Medicaid |
$4,227.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Humana KY Medicaid |
$4,227.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 3 RT
|
Facility
|
IP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 3 RT
|
Facility
|
OP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem Medicaid |
$4,227.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Humana KY Medicaid |
$4,227.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 4 LT
|
Facility
|
IP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 4 LT
|
Facility
|
OP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem Medicaid |
$4,227.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Humana KY Medicaid |
$4,227.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 4 RT
|
Facility
|
OP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem Medicaid |
$4,227.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Humana KY Medicaid |
$4,227.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 4 RT
|
Facility
|
IP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 5 LT
|
Facility
|
IP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 5 LT
|
Facility
|
OP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem Medicaid |
$4,227.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Humana KY Medicaid |
$4,227.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 5 RT
|
Facility
|
IP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 5 RT
|
Facility
|
OP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem Medicaid |
$4,227.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Humana KY Medicaid |
$4,227.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 6 LT
|
Facility
|
IP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 6 LT
|
Facility
|
OP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem Medicaid |
$4,227.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Humana KY Medicaid |
$4,227.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 6 RT
|
Facility
|
OP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem Medicaid |
$4,227.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Humana KY Medicaid |
$4,227.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 6 RT
|
Facility
|
IP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
|
TIB BASE JRNY W/O TAPE NP 7 LT
|
Facility
|
OP
|
$12,291.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,597.93 |
| Max. Negotiated Rate |
$11,800.10 |
| Rate for Payer: Aetna Commercial |
$9,464.66
|
| Rate for Payer: Anthem Medicaid |
$4,227.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,587.58
|
| Rate for Payer: Cash Price |
$6,145.89
|
| Rate for Payer: Cigna Commercial |
$10,202.17
|
| Rate for Payer: First Health Commercial |
$11,677.18
|
| Rate for Payer: Humana Commercial |
$10,448.00
|
| Rate for Payer: Humana KY Medicaid |
$4,227.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,270.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,079.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,071.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,687.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,311.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,816.76
|
| Rate for Payer: Ohio Health Group HMO |
$9,218.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,458.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,597.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,810.45
|
| Rate for Payer: PHCS Commercial |
$11,800.10
|
| Rate for Payer: United Healthcare All Payer |
$10,816.76
|
|
