|
TIB BASE SZ4 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 SZ4 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 SZ4 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 SZ4 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 SZ5 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 SZ5 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 SZ5 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 SZ5 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 SZ6 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 SZ6 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 SZ6 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 SZ6 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 W/JRNEY LOCK SZ 1 L
|
Facility
|
OP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem Medicaid |
$6,454.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Humana KY Medicaid |
$6,454.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,520.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,584.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
|
TIB BASE W/JRNEY LOCK SZ 1 L
|
Facility
|
IP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
|
TIB BASE W/JRNEY LOCK SZ 1 R
|
Facility
|
IP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
|
TIB BASE W/JRNEY LOCK SZ 1 R
|
Facility
|
OP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem Medicaid |
$6,454.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Humana KY Medicaid |
$6,454.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,520.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,584.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
|
TIB BASE W/JRNEY LOCK SZ 2 L
|
Facility
|
IP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
|
TIB BASE W/JRNEY LOCK SZ 2 L
|
Facility
|
OP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem Medicaid |
$6,454.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Humana KY Medicaid |
$6,454.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,520.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,584.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
|
TIB BASE W/JRNEY LOCK SZ 2 R
|
Facility
|
OP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem Medicaid |
$6,454.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Humana KY Medicaid |
$6,454.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,520.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,584.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
|
TIB BASE W/JRNEY LOCK SZ 2 R
|
Facility
|
IP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
|
TIB BASE W/JRNEY LOCK SZ 3 L
|
Facility
|
IP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
|
TIB BASE W/JRNEY LOCK SZ 3 L
|
Facility
|
OP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem Medicaid |
$6,454.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Humana KY Medicaid |
$6,454.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,520.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,584.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
|
TIB BASE W/JRNEY LOCK SZ 3 R
|
Facility
|
IP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
|
TIB BASE W/JRNEY LOCK SZ 3 R
|
Facility
|
OP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem Medicaid |
$6,454.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Humana KY Medicaid |
$6,454.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,520.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,584.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
|
TIB BASE W/JRNEY LOCK SZ 4 L
|
Facility
|
IP
|
$18,769.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,630.96 |
| Max. Negotiated Rate |
$18,019.08 |
| Rate for Payer: Aetna Commercial |
$14,452.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,640.51
|
| Rate for Payer: Cash Price |
$9,384.94
|
| Rate for Payer: Cigna Commercial |
$15,579.00
|
| Rate for Payer: First Health Commercial |
$17,831.39
|
| Rate for Payer: Humana Commercial |
$15,954.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,391.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,852.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,630.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,517.49
|
| Rate for Payer: Ohio Health Group HMO |
$14,077.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,015.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,329.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,951.22
|
| Rate for Payer: PHCS Commercial |
$18,019.08
|
| Rate for Payer: United Healthcare All Payer |
$16,517.49
|
|
