|
TIB BASE W/O HOLE POR HA SZ6 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 SZ6 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 SZ6 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 SZ6 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 SZ7 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 SZ7 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 SZ7 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 SZ7 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 SZ8 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 SZ8 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 SZ8 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 SZ8 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 BLOCK 6MM 83
|
Facility
|
OP
|
$8,064.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,048.42 |
| Max. Negotiated Rate |
$7,742.17 |
| Rate for Payer: Aetna Commercial |
$6,209.87
|
| Rate for Payer: Anthem Medicaid |
$2,773.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,290.51
|
| Rate for Payer: Cash Price |
$4,032.38
|
| Rate for Payer: Cigna Commercial |
$6,693.75
|
| Rate for Payer: First Health Commercial |
$7,661.52
|
| Rate for Payer: Humana Commercial |
$6,855.05
|
| Rate for Payer: Humana KY Medicaid |
$2,773.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,801.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,613.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,951.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,419.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,829.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,096.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,048.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,612.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,500.08
|
| Rate for Payer: PHCS Commercial |
$7,742.17
|
| Rate for Payer: United Healthcare All Payer |
$7,096.99
|
|
|
TIB BLOCK 6MM 83
|
Facility
|
IP
|
$8,064.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,048.42 |
| Max. Negotiated Rate |
$7,742.17 |
| Rate for Payer: Aetna Commercial |
$6,209.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,290.51
|
| Rate for Payer: Cash Price |
$4,032.38
|
| Rate for Payer: Cigna Commercial |
$6,693.75
|
| Rate for Payer: First Health Commercial |
$7,661.52
|
| Rate for Payer: Humana Commercial |
$6,855.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,613.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,951.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,419.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,096.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,048.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,612.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,500.08
|
| Rate for Payer: PHCS Commercial |
$7,742.17
|
| Rate for Payer: United Healthcare All Payer |
$7,096.99
|
|
|
TIB BLOCK OSS 20X63/67 ML/LR
|
Facility
|
IP
|
$9,269.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$8,898.49 |
| Rate for Payer: Aetna Commercial |
$7,137.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,230.02
|
| Rate for Payer: Cash Price |
$4,634.63
|
| Rate for Payer: Cigna Commercial |
$7,693.49
|
| Rate for Payer: First Health Commercial |
$8,805.80
|
| Rate for Payer: Humana Commercial |
$7,878.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,600.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,840.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,780.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,156.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,951.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,853.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.47
|
| Rate for Payer: PHCS Commercial |
$8,898.49
|
| Rate for Payer: United Healthcare All Payer |
$8,156.95
|
|
|
TIB BLOCK OSS 20X63/67 ML/LR
|
Facility
|
OP
|
$9,269.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$8,898.49 |
| Rate for Payer: Aetna Commercial |
$7,137.33
|
| Rate for Payer: Anthem Medicaid |
$3,187.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,230.02
|
| Rate for Payer: Cash Price |
$4,634.63
|
| Rate for Payer: Cigna Commercial |
$7,693.49
|
| Rate for Payer: First Health Commercial |
$8,805.80
|
| Rate for Payer: Humana Commercial |
$7,878.87
|
| Rate for Payer: Humana KY Medicaid |
$3,187.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,220.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,600.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,840.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,780.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,251.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,156.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,951.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,853.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.47
|
| Rate for Payer: PHCS Commercial |
$8,898.49
|
| Rate for Payer: United Healthcare All Payer |
$8,156.95
|
|
|
TIB BLOCK OSS 20X63/67 MR/LL
|
Facility
|
IP
|
$9,269.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$8,898.49 |
| Rate for Payer: Aetna Commercial |
$7,137.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,230.02
|
| Rate for Payer: Cash Price |
$4,634.63
|
| Rate for Payer: Cigna Commercial |
$7,693.49
|
| Rate for Payer: First Health Commercial |
$8,805.80
|
| Rate for Payer: Humana Commercial |
$7,878.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,600.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,840.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,780.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,156.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,951.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,853.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.47
|
| Rate for Payer: PHCS Commercial |
$8,898.49
|
| Rate for Payer: United Healthcare All Payer |
$8,156.95
|
|
|
TIB BLOCK OSS 20X63/67 MR/LL
|
Facility
|
OP
|
$9,269.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$8,898.49 |
| Rate for Payer: Aetna Commercial |
$7,137.33
|
| Rate for Payer: Anthem Medicaid |
$3,187.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,230.02
|
| Rate for Payer: Cash Price |
$4,634.63
|
| Rate for Payer: Cigna Commercial |
$7,693.49
|
| Rate for Payer: First Health Commercial |
$8,805.80
|
| Rate for Payer: Humana Commercial |
$7,878.87
|
| Rate for Payer: Humana KY Medicaid |
$3,187.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,220.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,600.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,840.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,780.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,251.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,156.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,951.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,853.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.47
|
| Rate for Payer: PHCS Commercial |
$8,898.49
|
| Rate for Payer: United Healthcare All Payer |
$8,156.95
|
|
|
TIB BLOCK OSS 20X71/75 ML/LR
|
Facility
|
OP
|
$9,269.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$8,898.49 |
| Rate for Payer: Aetna Commercial |
$7,137.33
|
| Rate for Payer: Anthem Medicaid |
$3,187.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,230.02
|
| Rate for Payer: Cash Price |
$4,634.63
|
| Rate for Payer: Cigna Commercial |
$7,693.49
|
| Rate for Payer: First Health Commercial |
$8,805.80
|
| Rate for Payer: Humana Commercial |
$7,878.87
|
| Rate for Payer: Humana KY Medicaid |
$3,187.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,220.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,600.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,840.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,780.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,251.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,156.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,951.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,853.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.47
|
| Rate for Payer: PHCS Commercial |
$8,898.49
|
| Rate for Payer: United Healthcare All Payer |
$8,156.95
|
|
|
TIB BLOCK OSS 20X71/75 ML/LR
|
Facility
|
IP
|
$9,269.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$8,898.49 |
| Rate for Payer: Aetna Commercial |
$7,137.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,230.02
|
| Rate for Payer: Cash Price |
$4,634.63
|
| Rate for Payer: Cigna Commercial |
$7,693.49
|
| Rate for Payer: First Health Commercial |
$8,805.80
|
| Rate for Payer: Humana Commercial |
$7,878.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,600.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,840.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,780.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,156.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,951.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,853.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.47
|
| Rate for Payer: PHCS Commercial |
$8,898.49
|
| Rate for Payer: United Healthcare All Payer |
$8,156.95
|
|
|
TIB BLOCK OSS 20X71/75 MR/LL
|
Facility
|
IP
|
$9,269.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$8,898.49 |
| Rate for Payer: Aetna Commercial |
$7,137.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,230.02
|
| Rate for Payer: Cash Price |
$4,634.63
|
| Rate for Payer: Cigna Commercial |
$7,693.49
|
| Rate for Payer: First Health Commercial |
$8,805.80
|
| Rate for Payer: Humana Commercial |
$7,878.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,600.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,840.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,780.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,156.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,951.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,853.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.47
|
| Rate for Payer: PHCS Commercial |
$8,898.49
|
| Rate for Payer: United Healthcare All Payer |
$8,156.95
|
|
|
TIB BLOCK OSS 20X71/75 MR/LL
|
Facility
|
OP
|
$9,269.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$8,898.49 |
| Rate for Payer: Aetna Commercial |
$7,137.33
|
| Rate for Payer: Anthem Medicaid |
$3,187.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,230.02
|
| Rate for Payer: Cash Price |
$4,634.63
|
| Rate for Payer: Cigna Commercial |
$7,693.49
|
| Rate for Payer: First Health Commercial |
$8,805.80
|
| Rate for Payer: Humana Commercial |
$7,878.87
|
| Rate for Payer: Humana KY Medicaid |
$3,187.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,220.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,600.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,840.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,780.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,251.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,156.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,951.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,853.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.47
|
| Rate for Payer: PHCS Commercial |
$8,898.49
|
| Rate for Payer: United Healthcare All Payer |
$8,156.95
|
|
|
TIB BLOCK OSS 20X79/83 ML/LR
|
Facility
|
IP
|
$9,269.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$8,898.49 |
| Rate for Payer: Aetna Commercial |
$7,137.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,230.02
|
| Rate for Payer: Cash Price |
$4,634.63
|
| Rate for Payer: Cigna Commercial |
$7,693.49
|
| Rate for Payer: First Health Commercial |
$8,805.80
|
| Rate for Payer: Humana Commercial |
$7,878.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,600.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,840.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,780.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,156.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,951.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,853.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.47
|
| Rate for Payer: PHCS Commercial |
$8,898.49
|
| Rate for Payer: United Healthcare All Payer |
$8,156.95
|
|
|
TIB BLOCK OSS 20X79/83 ML/LR
|
Facility
|
OP
|
$9,269.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$8,898.49 |
| Rate for Payer: Aetna Commercial |
$7,137.33
|
| Rate for Payer: Anthem Medicaid |
$3,187.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,230.02
|
| Rate for Payer: Cash Price |
$4,634.63
|
| Rate for Payer: Cigna Commercial |
$7,693.49
|
| Rate for Payer: First Health Commercial |
$8,805.80
|
| Rate for Payer: Humana Commercial |
$7,878.87
|
| Rate for Payer: Humana KY Medicaid |
$3,187.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,220.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,600.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,840.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,780.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,251.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,156.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,951.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,853.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.47
|
| Rate for Payer: PHCS Commercial |
$8,898.49
|
| Rate for Payer: United Healthcare All Payer |
$8,156.95
|
|
|
TIB BLOCK OSS 20X79/83 MR/LL
|
Facility
|
OP
|
$9,269.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.00 |
| Max. Negotiated Rate |
$8,898.49 |
| Rate for Payer: Aetna Commercial |
$7,137.33
|
| Rate for Payer: Anthem Medicaid |
$3,187.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,230.02
|
| Rate for Payer: Cash Price |
$4,634.63
|
| Rate for Payer: Cigna Commercial |
$7,693.49
|
| Rate for Payer: First Health Commercial |
$8,805.80
|
| Rate for Payer: Humana Commercial |
$7,878.87
|
| Rate for Payer: Humana KY Medicaid |
$3,187.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,220.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,600.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,840.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,780.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,251.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,156.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,951.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,853.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.47
|
| Rate for Payer: PHCS Commercial |
$8,898.49
|
| Rate for Payer: United Healthcare All Payer |
$8,156.95
|
|
