|
TIB ALL-POLY SZ6 10MM RM/LL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 12MM LM/RL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 12MM LM/RL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 12MM RM/LL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 12MM RM/LL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 14MM LM/RL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 14MM LM/RL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 14MM RM/LL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 14MM RM/LL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 8MM LM/RL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 8MM LM/RL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 8MM RM/LL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB ALL-POLY SZ6 8MM RM/LL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB AUG HALF BLOCK #11/10MM
|
Facility
|
OP
|
$5,129.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.70 |
| Max. Negotiated Rate |
$4,923.84 |
| Rate for Payer: Aetna Commercial |
$3,949.33
|
| Rate for Payer: Anthem Medicaid |
$1,763.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,000.62
|
| Rate for Payer: Cash Price |
$2,564.50
|
| Rate for Payer: Cigna Commercial |
$4,257.07
|
| Rate for Payer: First Health Commercial |
$4,872.55
|
| Rate for Payer: Humana Commercial |
$4,359.65
|
| Rate for Payer: Humana KY Medicaid |
$1,763.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,781.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,205.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,785.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,538.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,799.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,513.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,846.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,462.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,539.01
|
| Rate for Payer: PHCS Commercial |
$4,923.84
|
| Rate for Payer: United Healthcare All Payer |
$4,513.52
|
|
|
TIB AUG HALF BLOCK #11/10MM
|
Facility
|
IP
|
$5,129.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.70 |
| Max. Negotiated Rate |
$4,923.84 |
| Rate for Payer: Aetna Commercial |
$3,949.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,000.62
|
| Rate for Payer: Cash Price |
$2,564.50
|
| Rate for Payer: Cigna Commercial |
$4,257.07
|
| Rate for Payer: First Health Commercial |
$4,872.55
|
| Rate for Payer: Humana Commercial |
$4,359.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,205.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,785.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,538.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,513.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,846.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,462.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,539.01
|
| Rate for Payer: PHCS Commercial |
$4,923.84
|
| Rate for Payer: United Healthcare All Payer |
$4,513.52
|
|
|
TIB AUG HALF BLOCK #11/5MM
|
Facility
|
OP
|
$5,129.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.70 |
| Max. Negotiated Rate |
$4,923.84 |
| Rate for Payer: Aetna Commercial |
$3,949.33
|
| Rate for Payer: Anthem Medicaid |
$1,763.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,000.62
|
| Rate for Payer: Cash Price |
$2,564.50
|
| Rate for Payer: Cigna Commercial |
$4,257.07
|
| Rate for Payer: First Health Commercial |
$4,872.55
|
| Rate for Payer: Humana Commercial |
$4,359.65
|
| Rate for Payer: Humana KY Medicaid |
$1,763.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,781.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,205.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,785.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,538.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,799.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,513.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,846.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,462.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,539.01
|
| Rate for Payer: PHCS Commercial |
$4,923.84
|
| Rate for Payer: United Healthcare All Payer |
$4,513.52
|
|
|
TIB AUG HALF BLOCK #11/5MM
|
Facility
|
IP
|
$5,129.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.70 |
| Max. Negotiated Rate |
$4,923.84 |
| Rate for Payer: Aetna Commercial |
$3,949.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,000.62
|
| Rate for Payer: Cash Price |
$2,564.50
|
| Rate for Payer: Cigna Commercial |
$4,257.07
|
| Rate for Payer: First Health Commercial |
$4,872.55
|
| Rate for Payer: Humana Commercial |
$4,359.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,205.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,785.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,538.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,513.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,846.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,462.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,539.01
|
| Rate for Payer: PHCS Commercial |
$4,923.84
|
| Rate for Payer: United Healthcare All Payer |
$4,513.52
|
|
|
TIB AUG HALF BLOCK #13/10MM
|
Facility
|
IP
|
$5,285.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.50 |
| Max. Negotiated Rate |
$5,073.60 |
| Rate for Payer: Aetna Commercial |
$4,069.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,122.30
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$4,386.55
|
| Rate for Payer: First Health Commercial |
$5,020.75
|
| Rate for Payer: Humana Commercial |
$4,492.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,333.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,900.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,585.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,650.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,597.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,646.65
|
| Rate for Payer: PHCS Commercial |
$5,073.60
|
| Rate for Payer: United Healthcare All Payer |
$4,650.80
|
|
|
TIB AUG HALF BLOCK #13/10MM
|
Facility
|
OP
|
$5,285.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.50 |
| Max. Negotiated Rate |
$5,073.60 |
| Rate for Payer: Aetna Commercial |
$4,069.45
|
| Rate for Payer: Anthem Medicaid |
$1,817.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,122.30
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$4,386.55
|
| Rate for Payer: First Health Commercial |
$5,020.75
|
| Rate for Payer: Humana Commercial |
$4,492.25
|
| Rate for Payer: Humana KY Medicaid |
$1,817.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,836.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,333.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,900.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,585.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,853.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,650.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,597.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,646.65
|
| Rate for Payer: PHCS Commercial |
$5,073.60
|
| Rate for Payer: United Healthcare All Payer |
$4,650.80
|
|
|
TIB AUG HALF BLOCK #13/5MM
|
Facility
|
OP
|
$5,285.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.50 |
| Max. Negotiated Rate |
$5,073.60 |
| Rate for Payer: Aetna Commercial |
$4,069.45
|
| Rate for Payer: Anthem Medicaid |
$1,817.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,122.30
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$4,386.55
|
| Rate for Payer: First Health Commercial |
$5,020.75
|
| Rate for Payer: Humana Commercial |
$4,492.25
|
| Rate for Payer: Humana KY Medicaid |
$1,817.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,836.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,333.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,900.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,585.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,853.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,650.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,597.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,646.65
|
| Rate for Payer: PHCS Commercial |
$5,073.60
|
| Rate for Payer: United Healthcare All Payer |
$4,650.80
|
|
|
TIB AUG HALF BLOCK #13/5MM
|
Facility
|
IP
|
$5,285.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.50 |
| Max. Negotiated Rate |
$5,073.60 |
| Rate for Payer: Aetna Commercial |
$4,069.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,122.30
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$4,386.55
|
| Rate for Payer: First Health Commercial |
$5,020.75
|
| Rate for Payer: Humana Commercial |
$4,492.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,333.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,900.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,585.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,650.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,597.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,646.65
|
| Rate for Payer: PHCS Commercial |
$5,073.60
|
| Rate for Payer: United Healthcare All Payer |
$4,650.80
|
|
|
TIB AUG HALF BLOCK #3/10MM
|
Facility
|
OP
|
$5,285.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.50 |
| Max. Negotiated Rate |
$5,073.60 |
| Rate for Payer: Aetna Commercial |
$4,069.45
|
| Rate for Payer: Anthem Medicaid |
$1,817.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,122.30
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$4,386.55
|
| Rate for Payer: First Health Commercial |
$5,020.75
|
| Rate for Payer: Humana Commercial |
$4,492.25
|
| Rate for Payer: Humana KY Medicaid |
$1,817.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,836.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,333.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,900.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,585.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,853.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,650.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,597.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,646.65
|
| Rate for Payer: PHCS Commercial |
$5,073.60
|
| Rate for Payer: United Healthcare All Payer |
$4,650.80
|
|
|
TIB AUG HALF BLOCK #3/10MM
|
Facility
|
IP
|
$5,285.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.50 |
| Max. Negotiated Rate |
$5,073.60 |
| Rate for Payer: Aetna Commercial |
$4,069.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,122.30
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: Cigna Commercial |
$4,386.55
|
| Rate for Payer: First Health Commercial |
$5,020.75
|
| Rate for Payer: Humana Commercial |
$4,492.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,333.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,900.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,585.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,650.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,597.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,646.65
|
| Rate for Payer: PHCS Commercial |
$5,073.60
|
| Rate for Payer: United Healthcare All Payer |
$4,650.80
|
|
|
TIB AUG HALF BLOCK #3/5MM
|
Facility
|
OP
|
$5,549.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,664.70 |
| Max. Negotiated Rate |
$5,327.04 |
| Rate for Payer: Aetna Commercial |
$4,272.73
|
| Rate for Payer: Anthem Medicaid |
$1,908.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,328.22
|
| Rate for Payer: Cash Price |
$2,774.50
|
| Rate for Payer: Cigna Commercial |
$4,605.67
|
| Rate for Payer: First Health Commercial |
$5,271.55
|
| Rate for Payer: Humana Commercial |
$4,716.65
|
| Rate for Payer: Humana KY Medicaid |
$1,908.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,927.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,550.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,095.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,664.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,946.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,883.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,161.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,439.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,827.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,828.81
|
| Rate for Payer: PHCS Commercial |
$5,327.04
|
| Rate for Payer: United Healthcare All Payer |
$4,883.12
|
|
|
TIB AUG HALF BLOCK #3/5MM
|
Facility
|
IP
|
$5,549.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,664.70 |
| Max. Negotiated Rate |
$5,327.04 |
| Rate for Payer: Aetna Commercial |
$4,272.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,328.22
|
| Rate for Payer: Cash Price |
$2,774.50
|
| Rate for Payer: Cigna Commercial |
$4,605.67
|
| Rate for Payer: First Health Commercial |
$5,271.55
|
| Rate for Payer: Humana Commercial |
$4,716.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,550.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,095.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,664.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,883.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,161.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,439.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,827.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,828.81
|
| Rate for Payer: PHCS Commercial |
$5,327.04
|
| Rate for Payer: United Healthcare All Payer |
$4,883.12
|
|
