|
TIB FULL BLOCK #9 10MM
|
Facility
|
OP
|
$8,310.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.31 |
| Max. Negotiated Rate |
$7,977.64 |
| Rate for Payer: Aetna Commercial |
$6,398.73
|
| Rate for Payer: Anthem Medicaid |
$2,857.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,481.83
|
| Rate for Payer: Cash Price |
$4,155.02
|
| Rate for Payer: Cigna Commercial |
$6,897.33
|
| Rate for Payer: First Health Commercial |
$7,894.54
|
| Rate for Payer: Humana Commercial |
$7,063.53
|
| Rate for Payer: Humana KY Medicaid |
$2,857.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,886.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,814.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,132.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,493.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,915.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,312.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,232.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,662.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,080.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,576.11
|
| Rate for Payer: PHCS Commercial |
$7,977.64
|
| Rate for Payer: United Healthcare All Payer |
$7,312.84
|
|
|
TIB FULL BLOCK #9 10MM
|
Facility
|
IP
|
$8,310.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.31 |
| Max. Negotiated Rate |
$7,977.64 |
| Rate for Payer: Aetna Commercial |
$6,398.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,481.83
|
| Rate for Payer: Cash Price |
$4,155.02
|
| Rate for Payer: Cigna Commercial |
$6,897.33
|
| Rate for Payer: First Health Commercial |
$7,894.54
|
| Rate for Payer: Humana Commercial |
$7,063.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,814.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,132.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,493.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,312.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,232.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,662.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,080.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,576.11
|
| Rate for Payer: PHCS Commercial |
$7,977.64
|
| Rate for Payer: United Healthcare All Payer |
$7,312.84
|
|
|
TIB FULLWDG RK/HK LGN 1-2 10MM
|
Facility
|
OP
|
$11,125.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.33 |
| Max. Negotiated Rate |
$10,680.58 |
| Rate for Payer: Aetna Commercial |
$8,566.71
|
| Rate for Payer: Anthem Medicaid |
$3,826.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,677.97
|
| Rate for Payer: Cash Price |
$5,562.80
|
| Rate for Payer: Cigna Commercial |
$9,234.25
|
| Rate for Payer: First Health Commercial |
$10,569.32
|
| Rate for Payer: Humana Commercial |
$9,456.76
|
| Rate for Payer: Humana KY Medicaid |
$3,826.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,865.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,122.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,210.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,337.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,902.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,790.53
|
| Rate for Payer: Ohio Health Group HMO |
$8,344.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,225.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,446.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,448.94
|
| Rate for Payer: PHCS Commercial |
$10,680.58
|
| Rate for Payer: United Healthcare All Payer |
$9,790.53
|
|
|
TIB FULLWDG RK/HK LGN 1-2 10MM
|
Facility
|
IP
|
$11,125.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.33 |
| Max. Negotiated Rate |
$10,680.58 |
| Rate for Payer: Aetna Commercial |
$8,566.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,677.97
|
| Rate for Payer: Cash Price |
$5,562.80
|
| Rate for Payer: Cigna Commercial |
$9,234.25
|
| Rate for Payer: First Health Commercial |
$10,569.32
|
| Rate for Payer: Humana Commercial |
$9,456.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,122.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,210.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,337.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,790.53
|
| Rate for Payer: Ohio Health Group HMO |
$8,344.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,225.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,446.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,448.94
|
| Rate for Payer: PHCS Commercial |
$10,680.58
|
| Rate for Payer: United Healthcare All Payer |
$9,790.53
|
|
|
TIB FULLWDG RK/HK LGN 1-2 15MM
|
Facility
|
IP
|
$11,016.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.09 |
| Max. Negotiated Rate |
$10,575.46 |
| Rate for Payer: Aetna Commercial |
$8,482.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,592.56
|
| Rate for Payer: Cash Price |
$5,508.05
|
| Rate for Payer: Cigna Commercial |
$9,143.36
|
| Rate for Payer: First Health Commercial |
$10,465.30
|
| Rate for Payer: Humana Commercial |
$9,363.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,129.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,304.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,694.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,262.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.99
|
| Rate for Payer: PHCS Commercial |
$10,575.46
|
| Rate for Payer: United Healthcare All Payer |
$9,694.17
|
|
|
TIB FULLWDG RK/HK LGN 1-2 15MM
|
Facility
|
OP
|
$11,016.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.09 |
| Max. Negotiated Rate |
$10,575.46 |
| Rate for Payer: Aetna Commercial |
$8,482.40
|
| Rate for Payer: Anthem Medicaid |
$3,788.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,592.56
|
| Rate for Payer: Cash Price |
$5,508.05
|
| Rate for Payer: Cigna Commercial |
$9,143.36
|
| Rate for Payer: First Health Commercial |
$10,465.30
|
| Rate for Payer: Humana Commercial |
$9,363.68
|
| Rate for Payer: Humana KY Medicaid |
$3,788.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,826.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,129.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,304.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,864.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,694.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,262.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.99
|
| Rate for Payer: PHCS Commercial |
$10,575.46
|
| Rate for Payer: United Healthcare All Payer |
$9,694.17
|
|
|
TIB FULLWDG RK/HK LGN 3-4 10MM
|
Facility
|
IP
|
$11,125.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.33 |
| Max. Negotiated Rate |
$10,680.58 |
| Rate for Payer: Aetna Commercial |
$8,566.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,677.97
|
| Rate for Payer: Cash Price |
$5,562.80
|
| Rate for Payer: Cigna Commercial |
$9,234.25
|
| Rate for Payer: First Health Commercial |
$10,569.32
|
| Rate for Payer: Humana Commercial |
$9,456.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,122.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,210.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,337.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,790.53
|
| Rate for Payer: Ohio Health Group HMO |
$8,344.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,225.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,446.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,448.94
|
| Rate for Payer: PHCS Commercial |
$10,680.58
|
| Rate for Payer: United Healthcare All Payer |
$9,790.53
|
|
|
TIB FULLWDG RK/HK LGN 3-4 10MM
|
Facility
|
OP
|
$11,125.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.33 |
| Max. Negotiated Rate |
$10,680.58 |
| Rate for Payer: Aetna Commercial |
$8,566.71
|
| Rate for Payer: Anthem Medicaid |
$3,826.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,677.97
|
| Rate for Payer: Cash Price |
$5,562.80
|
| Rate for Payer: Cigna Commercial |
$9,234.25
|
| Rate for Payer: First Health Commercial |
$10,569.32
|
| Rate for Payer: Humana Commercial |
$9,456.76
|
| Rate for Payer: Humana KY Medicaid |
$3,826.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,865.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,122.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,210.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,337.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,902.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,790.53
|
| Rate for Payer: Ohio Health Group HMO |
$8,344.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,225.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,446.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,448.94
|
| Rate for Payer: PHCS Commercial |
$10,680.58
|
| Rate for Payer: United Healthcare All Payer |
$9,790.53
|
|
|
TIB FULLWDG RK/HK LGN 3-4 15MM
|
Facility
|
OP
|
$11,016.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.09 |
| Max. Negotiated Rate |
$10,575.46 |
| Rate for Payer: Aetna Commercial |
$8,482.40
|
| Rate for Payer: Anthem Medicaid |
$3,788.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,592.56
|
| Rate for Payer: Cash Price |
$5,508.05
|
| Rate for Payer: Cigna Commercial |
$9,143.36
|
| Rate for Payer: First Health Commercial |
$10,465.30
|
| Rate for Payer: Humana Commercial |
$9,363.68
|
| Rate for Payer: Humana KY Medicaid |
$3,788.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,826.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,129.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,304.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,864.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,694.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,262.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.99
|
| Rate for Payer: PHCS Commercial |
$10,575.46
|
| Rate for Payer: United Healthcare All Payer |
$9,694.17
|
|
|
TIB FULLWDG RK/HK LGN 3-4 15MM
|
Facility
|
IP
|
$11,016.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.09 |
| Max. Negotiated Rate |
$10,575.46 |
| Rate for Payer: Aetna Commercial |
$8,482.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,592.56
|
| Rate for Payer: Cash Price |
$5,508.05
|
| Rate for Payer: Cigna Commercial |
$9,143.36
|
| Rate for Payer: First Health Commercial |
$10,465.30
|
| Rate for Payer: Humana Commercial |
$9,363.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,129.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,304.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,694.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,262.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.99
|
| Rate for Payer: PHCS Commercial |
$10,575.46
|
| Rate for Payer: United Healthcare All Payer |
$9,694.17
|
|
|
TIB FULLWDG RK/HK LGN 5-6 10MM
|
Facility
|
IP
|
$11,676.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,517.98 |
| Max. Negotiated Rate |
$11,209.68 |
| Rate for Payer: Aetna Commercial |
$8,991.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,107.86
|
| Rate for Payer: Cash Price |
$5,838.38
|
| Rate for Payer: Cigna Commercial |
$9,691.70
|
| Rate for Payer: First Health Commercial |
$11,092.91
|
| Rate for Payer: Humana Commercial |
$9,925.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,574.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,617.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,503.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,275.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,757.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,335.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,619.79
|
| Rate for Payer: PHCS Commercial |
$11,209.68
|
| Rate for Payer: United Healthcare All Payer |
$10,275.54
|
|
|
TIB FULLWDG RK/HK LGN 5-6 10MM
|
Facility
|
OP
|
$11,676.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,517.98 |
| Max. Negotiated Rate |
$11,209.68 |
| Rate for Payer: Aetna Commercial |
$8,991.10
|
| Rate for Payer: Anthem Medicaid |
$4,015.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,107.86
|
| Rate for Payer: Cash Price |
$5,838.38
|
| Rate for Payer: Cigna Commercial |
$9,691.70
|
| Rate for Payer: First Health Commercial |
$11,092.91
|
| Rate for Payer: Humana Commercial |
$9,925.24
|
| Rate for Payer: Humana KY Medicaid |
$4,015.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,056.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,574.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,617.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,503.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,096.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,275.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,757.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,335.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,619.79
|
| Rate for Payer: PHCS Commercial |
$11,209.68
|
| Rate for Payer: United Healthcare All Payer |
$10,275.54
|
|
|
TIB FULLWDG RK/HK LGN 5-6 15MM
|
Facility
|
OP
|
$11,016.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.09 |
| Max. Negotiated Rate |
$10,575.46 |
| Rate for Payer: Aetna Commercial |
$8,482.40
|
| Rate for Payer: Anthem Medicaid |
$3,788.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,592.56
|
| Rate for Payer: Cash Price |
$5,508.05
|
| Rate for Payer: Cigna Commercial |
$9,143.36
|
| Rate for Payer: First Health Commercial |
$10,465.30
|
| Rate for Payer: Humana Commercial |
$9,363.68
|
| Rate for Payer: Humana KY Medicaid |
$3,788.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,826.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,129.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,304.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,864.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,694.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,262.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.99
|
| Rate for Payer: PHCS Commercial |
$10,575.46
|
| Rate for Payer: United Healthcare All Payer |
$9,694.17
|
|
|
TIB FULLWDG RK/HK LGN 5-6 15MM
|
Facility
|
IP
|
$11,016.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.09 |
| Max. Negotiated Rate |
$10,575.46 |
| Rate for Payer: Aetna Commercial |
$8,482.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,592.56
|
| Rate for Payer: Cash Price |
$5,508.05
|
| Rate for Payer: Cigna Commercial |
$9,143.36
|
| Rate for Payer: First Health Commercial |
$10,465.30
|
| Rate for Payer: Humana Commercial |
$9,363.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,129.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,304.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,694.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,262.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,203.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,432.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,414.99
|
| Rate for Payer: PHCS Commercial |
$10,575.46
|
| Rate for Payer: United Healthcare All Payer |
$9,694.17
|
|
|
TIB FULLWDG RK/HK LGN 7-8 10MM
|
Facility
|
IP
|
$9,621.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.84 |
| Max. Negotiated Rate |
$9,236.98 |
| Rate for Payer: Aetna Commercial |
$7,408.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,505.04
|
| Rate for Payer: Cash Price |
$4,810.92
|
| Rate for Payer: Cigna Commercial |
$7,986.14
|
| Rate for Payer: First Health Commercial |
$9,140.76
|
| Rate for Payer: Humana Commercial |
$8,178.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,889.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,100.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,467.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,216.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,924.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,250.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,982.77
|
| Rate for Payer: PHCS Commercial |
$9,236.98
|
| Rate for Payer: United Healthcare All Payer |
$8,467.23
|
|
|
TIB FULLWDG RK/HK LGN 7-8 10MM
|
Facility
|
OP
|
$9,621.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.84 |
| Max. Negotiated Rate |
$9,236.98 |
| Rate for Payer: Aetna Commercial |
$7,408.82
|
| Rate for Payer: Anthem Medicaid |
$3,308.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,505.04
|
| Rate for Payer: Cash Price |
$4,810.92
|
| Rate for Payer: Cigna Commercial |
$7,986.14
|
| Rate for Payer: First Health Commercial |
$9,140.76
|
| Rate for Payer: Humana Commercial |
$8,178.57
|
| Rate for Payer: Humana KY Medicaid |
$3,308.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,889.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,100.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,375.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,467.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,216.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,924.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,250.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,982.77
|
| Rate for Payer: PHCS Commercial |
$9,236.98
|
| Rate for Payer: United Healthcare All Payer |
$8,467.23
|
|
|
TIB FULLWDG RK/HK LGN 7-8 15MM
|
Facility
|
OP
|
$9,621.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.84 |
| Max. Negotiated Rate |
$9,236.98 |
| Rate for Payer: Aetna Commercial |
$7,408.82
|
| Rate for Payer: Anthem Medicaid |
$3,308.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,505.04
|
| Rate for Payer: Cash Price |
$4,810.92
|
| Rate for Payer: Cigna Commercial |
$7,986.14
|
| Rate for Payer: First Health Commercial |
$9,140.76
|
| Rate for Payer: Humana Commercial |
$8,178.57
|
| Rate for Payer: Humana KY Medicaid |
$3,308.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,889.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,100.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,375.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,467.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,216.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,924.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,250.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,982.77
|
| Rate for Payer: PHCS Commercial |
$9,236.98
|
| Rate for Payer: United Healthcare All Payer |
$8,467.23
|
|
|
TIB FULLWDG RK/HK LGN 7-8 15MM
|
Facility
|
IP
|
$9,621.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.84 |
| Max. Negotiated Rate |
$9,236.98 |
| Rate for Payer: Aetna Commercial |
$7,408.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,505.04
|
| Rate for Payer: Cash Price |
$4,810.92
|
| Rate for Payer: Cigna Commercial |
$7,986.14
|
| Rate for Payer: First Health Commercial |
$9,140.76
|
| Rate for Payer: Humana Commercial |
$8,178.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,889.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,100.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,467.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,216.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,924.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,250.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,982.77
|
| Rate for Payer: PHCS Commercial |
$9,236.98
|
| Rate for Payer: United Healthcare All Payer |
$8,467.23
|
|
|
TIB GNS II CMT W/O TAPER SZ7 L
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIB GNS II CMT W/O TAPER SZ7 L
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIB GNS II CMT W/O TAPER SZ7 R
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIB GNS II CMT W/O TAPER SZ7 R
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIB GNS II CMT W/O TAPER SZ8 L
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIB GNS II CMT W/O TAPER SZ8 L
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
TIB GNS II CMT W/O TAPER SZ8 R
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
