|
TIB AUG HALF BLOCK #5/10MM
|
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 #5/10MM
|
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 #5/5MM
|
Facility
|
IP
|
$5,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,613.40 |
| Max. Negotiated Rate |
$5,162.88 |
| Rate for Payer: Aetna Commercial |
$4,141.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,194.84
|
| Rate for Payer: Cash Price |
$2,689.00
|
| Rate for Payer: Cigna Commercial |
$4,463.74
|
| Rate for Payer: First Health Commercial |
$5,109.10
|
| Rate for Payer: Humana Commercial |
$4,571.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,409.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,968.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,613.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,732.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,678.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,710.82
|
| Rate for Payer: PHCS Commercial |
$5,162.88
|
| Rate for Payer: United Healthcare All Payer |
$4,732.64
|
|
|
TIB AUG HALF BLOCK #5/5MM
|
Facility
|
OP
|
$5,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,613.40 |
| Max. Negotiated Rate |
$5,162.88 |
| Rate for Payer: Aetna Commercial |
$4,141.06
|
| Rate for Payer: Anthem Medicaid |
$1,849.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,194.84
|
| Rate for Payer: Cash Price |
$2,689.00
|
| Rate for Payer: Cigna Commercial |
$4,463.74
|
| Rate for Payer: First Health Commercial |
$5,109.10
|
| Rate for Payer: Humana Commercial |
$4,571.30
|
| Rate for Payer: Humana KY Medicaid |
$1,849.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,868.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,409.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,968.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,613.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,886.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,732.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,033.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,678.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,710.82
|
| Rate for Payer: PHCS Commercial |
$5,162.88
|
| Rate for Payer: United Healthcare All Payer |
$4,732.64
|
|
|
TIB AUG HALF BLOCK #7/10MM
|
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 #7/10MM
|
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 #9/10MM
|
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 #9/10MM
|
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 #9/5MM
|
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 #9/5MM
|
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 BASE JRNY W/O TAPE NP 2 LT
|
Facility
|
IP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 2 LT
|
Facility
|
OP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem Medicaid |
$4,312.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Humana KY Medicaid |
$4,312.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,356.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,399.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 2 RT
|
Facility
|
OP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem Medicaid |
$4,312.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Humana KY Medicaid |
$4,312.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,356.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,399.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 2 RT
|
Facility
|
IP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 3 LT
|
Facility
|
OP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem Medicaid |
$4,312.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Humana KY Medicaid |
$4,312.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,356.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,399.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 3 LT
|
Facility
|
IP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 3 RT
|
Facility
|
IP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 3 RT
|
Facility
|
OP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem Medicaid |
$4,312.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Humana KY Medicaid |
$4,312.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,356.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,399.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 4 LT
|
Facility
|
IP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 4 LT
|
Facility
|
OP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem Medicaid |
$4,312.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Humana KY Medicaid |
$4,312.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,356.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,399.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 4 RT
|
Facility
|
OP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem Medicaid |
$4,312.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Humana KY Medicaid |
$4,312.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,356.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,399.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 4 RT
|
Facility
|
IP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 5 LT
|
Facility
|
IP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 5 LT
|
Facility
|
OP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem Medicaid |
$4,312.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Humana KY Medicaid |
$4,312.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,356.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,399.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
|
TIB BASE JRNY W/O TAPE NP 5 RT
|
Facility
|
OP
|
$12,541.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,762.31 |
| Max. Negotiated Rate |
$12,039.40 |
| Rate for Payer: Aetna Commercial |
$9,656.60
|
| Rate for Payer: Anthem Medicaid |
$4,312.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,782.01
|
| Rate for Payer: Cash Price |
$6,270.52
|
| Rate for Payer: Cigna Commercial |
$10,409.06
|
| Rate for Payer: First Health Commercial |
$11,913.99
|
| Rate for Payer: Humana Commercial |
$10,659.88
|
| Rate for Payer: Humana KY Medicaid |
$4,312.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,356.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,283.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,255.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,762.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,399.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,036.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,405.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,032.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,910.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,653.32
|
| Rate for Payer: PHCS Commercial |
$12,039.40
|
| Rate for Payer: United Healthcare All Payer |
$11,036.12
|
|
