|
TIB BASE JRNY W/O TAPE NP 5 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 6 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 6 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 6 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 6 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 7 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 7 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 7 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 7 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 8 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 8 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 8 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 8 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 SZ1 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 BASE SZ1 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 BASE SZ1 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 BASE SZ1 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 BASE SZ2 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 BASE SZ2 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 BASE SZ2 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 BASE SZ2 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 BASE SZ3 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 BASE SZ3 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 BASE SZ3 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 BASE SZ3 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
|
|
