|
TIB BASE W/JRNEY LOCK SZ 5 R
|
Facility
|
IP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/JRNEY LOCK SZ 6 L
|
Facility
|
IP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/JRNEY LOCK SZ 6 L
|
Facility
|
OP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem Medicaid |
$6,252.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Humana KY Medicaid |
$6,252.62
|
| Rate for Payer: Kentucky WC Medicaid |
$6,316.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,378.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/JRNEY LOCK SZ 6 R
|
Facility
|
OP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem Medicaid |
$6,252.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Humana KY Medicaid |
$6,252.62
|
| Rate for Payer: Kentucky WC Medicaid |
$6,316.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,378.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/JRNEY LOCK SZ 6 R
|
Facility
|
IP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/JRNEY LOCK SZ 7 L
|
Facility
|
OP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem Medicaid |
$6,252.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Humana KY Medicaid |
$6,252.62
|
| Rate for Payer: Kentucky WC Medicaid |
$6,316.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,378.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/JRNEY LOCK SZ 7 L
|
Facility
|
IP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/JRNEY LOCK SZ 7 R
|
Facility
|
IP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/JRNEY LOCK SZ 7 R
|
Facility
|
OP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem Medicaid |
$6,252.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Humana KY Medicaid |
$6,252.62
|
| Rate for Payer: Kentucky WC Medicaid |
$6,316.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,378.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/JRNEY LOCK SZ 8 L
|
Facility
|
OP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem Medicaid |
$6,252.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Humana KY Medicaid |
$6,252.62
|
| Rate for Payer: Kentucky WC Medicaid |
$6,316.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,378.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/JRNEY LOCK SZ 8 L
|
Facility
|
IP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/JRNEY LOCK SZ 8 R
|
Facility
|
OP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem Medicaid |
$6,252.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Humana KY Medicaid |
$6,252.62
|
| Rate for Payer: Kentucky WC Medicaid |
$6,316.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,378.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/JRNEY LOCK SZ 8 R
|
Facility
|
IP
|
$18,181.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.60 |
| Max. Negotiated Rate |
$17,454.24 |
| Rate for Payer: Aetna Commercial |
$13,999.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,181.57
|
| Rate for Payer: Cash Price |
$9,090.75
|
| Rate for Payer: Cigna Commercial |
$15,090.64
|
| Rate for Payer: First Health Commercial |
$17,272.42
|
| Rate for Payer: Humana Commercial |
$15,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,908.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,417.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,454.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,999.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,636.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,363.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,636.26
|
| Rate for Payer: PHCS Commercial |
$17,454.24
|
| Rate for Payer: United Healthcare All Payer |
$15,999.72
|
|
|
TIB BASE W/O HOLE POR HA SZ2 R
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TIB BASE W/O HOLE POR HA SZ2 R
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TIB BASE W/O HOLE POR HA SZ3 R
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TIB BASE W/O HOLE POR HA SZ3 R
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TIB BASE W/O HOLE POR HA SZ4 L
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TIB BASE W/O HOLE POR HA SZ4 L
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TIB BASE W/O HOLE POR HA SZ4 R
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TIB BASE W/O HOLE POR HA SZ4 R
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TIB BASE W/O HOLE POR HA SZ5 L
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TIB BASE W/O HOLE POR HA SZ5 L
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TIB BASE W/O HOLE POR HA SZ5 R
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
TIB BASE W/O HOLE POR HA SZ5 R
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
