|
TIB CR PLY GNS SZ 1 9MM LT
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB CR PLY GNS SZ 1 9MM LT
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB FULL BLOCK #5 10MM
|
Facility
|
OP
|
$8,510.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,553.01 |
| Max. Negotiated Rate |
$8,169.64 |
| Rate for Payer: Aetna Commercial |
$6,552.73
|
| Rate for Payer: Anthem Medicaid |
$2,926.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,637.83
|
| Rate for Payer: Cash Price |
$4,255.02
|
| Rate for Payer: Cigna Commercial |
$7,063.33
|
| Rate for Payer: First Health Commercial |
$8,084.54
|
| Rate for Payer: Humana Commercial |
$7,233.53
|
| Rate for Payer: Humana KY Medicaid |
$2,926.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,956.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,978.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,280.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,553.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,985.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,488.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,382.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,808.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,403.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,871.93
|
| Rate for Payer: PHCS Commercial |
$8,169.64
|
| Rate for Payer: United Healthcare All Payer |
$7,488.84
|
|
|
TIB FULL BLOCK #5 10MM
|
Facility
|
IP
|
$8,510.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,553.01 |
| Max. Negotiated Rate |
$8,169.64 |
| Rate for Payer: Aetna Commercial |
$6,552.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,637.83
|
| Rate for Payer: Cash Price |
$4,255.02
|
| Rate for Payer: Cigna Commercial |
$7,063.33
|
| Rate for Payer: First Health Commercial |
$8,084.54
|
| Rate for Payer: Humana Commercial |
$7,233.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,978.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,280.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,553.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,488.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,382.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,808.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,403.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,871.93
|
| Rate for Payer: PHCS Commercial |
$8,169.64
|
| Rate for Payer: United Healthcare All Payer |
$7,488.84
|
|
|
TIB FULL BLOCK #7 10MM
|
Facility
|
IP
|
$8,197.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.28 |
| Max. Negotiated Rate |
$7,869.70 |
| Rate for Payer: Aetna Commercial |
$6,312.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,394.13
|
| Rate for Payer: Cash Price |
$4,098.80
|
| Rate for Payer: Cigna Commercial |
$6,804.01
|
| Rate for Payer: First Health Commercial |
$7,787.72
|
| Rate for Payer: Humana Commercial |
$6,967.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,722.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,049.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,459.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,213.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,148.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,558.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,131.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,656.34
|
| Rate for Payer: PHCS Commercial |
$7,869.70
|
| Rate for Payer: United Healthcare All Payer |
$7,213.89
|
|
|
TIB FULL BLOCK #7 10MM
|
Facility
|
OP
|
$8,197.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.28 |
| Max. Negotiated Rate |
$7,869.70 |
| Rate for Payer: Aetna Commercial |
$6,312.15
|
| Rate for Payer: Anthem Medicaid |
$2,819.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,394.13
|
| Rate for Payer: Cash Price |
$4,098.80
|
| Rate for Payer: Cigna Commercial |
$6,804.01
|
| Rate for Payer: First Health Commercial |
$7,787.72
|
| Rate for Payer: Humana Commercial |
$6,967.96
|
| Rate for Payer: Humana KY Medicaid |
$2,819.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,847.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,722.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,049.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,459.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,875.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,213.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,148.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,558.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,131.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,656.34
|
| Rate for Payer: PHCS Commercial |
$7,869.70
|
| Rate for Payer: United Healthcare All Payer |
$7,213.89
|
|
|
TIB FULL BLOCK #9 10MM
|
Facility
|
IP
|
$8,510.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,553.01 |
| Max. Negotiated Rate |
$8,169.64 |
| Rate for Payer: Aetna Commercial |
$6,552.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,637.83
|
| Rate for Payer: Cash Price |
$4,255.02
|
| Rate for Payer: Cigna Commercial |
$7,063.33
|
| Rate for Payer: First Health Commercial |
$8,084.54
|
| Rate for Payer: Humana Commercial |
$7,233.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,978.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,280.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,553.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,488.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,382.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,808.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,403.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,871.93
|
| Rate for Payer: PHCS Commercial |
$8,169.64
|
| Rate for Payer: United Healthcare All Payer |
$7,488.84
|
|
|
TIB FULL BLOCK #9 10MM
|
Facility
|
OP
|
$8,510.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,553.01 |
| Max. Negotiated Rate |
$8,169.64 |
| Rate for Payer: Aetna Commercial |
$6,552.73
|
| Rate for Payer: Anthem Medicaid |
$2,926.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,637.83
|
| Rate for Payer: Cash Price |
$4,255.02
|
| Rate for Payer: Cigna Commercial |
$7,063.33
|
| Rate for Payer: First Health Commercial |
$8,084.54
|
| Rate for Payer: Humana Commercial |
$7,233.53
|
| Rate for Payer: Humana KY Medicaid |
$2,926.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,956.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,978.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,280.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,553.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,985.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,488.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,382.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,808.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,403.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,871.93
|
| Rate for Payer: PHCS Commercial |
$8,169.64
|
| Rate for Payer: United Healthcare All Payer |
$7,488.84
|
|
|
TIB FULLWDG RK/HK LGN 1-2 10MM
|
Facility
|
IP
|
$11,368.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,410.54 |
| Max. Negotiated Rate |
$10,913.74 |
| Rate for Payer: Aetna Commercial |
$8,753.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,867.41
|
| Rate for Payer: Cash Price |
$5,684.24
|
| Rate for Payer: Cigna Commercial |
$9,435.84
|
| Rate for Payer: First Health Commercial |
$10,800.06
|
| Rate for Payer: Humana Commercial |
$9,663.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,322.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,389.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,410.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,004.26
|
| Rate for Payer: Ohio Health Group HMO |
$8,526.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,094.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,890.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,844.25
|
| Rate for Payer: PHCS Commercial |
$10,913.74
|
| Rate for Payer: United Healthcare All Payer |
$10,004.26
|
|
|
TIB FULLWDG RK/HK LGN 1-2 10MM
|
Facility
|
OP
|
$11,368.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,410.54 |
| Max. Negotiated Rate |
$10,913.74 |
| Rate for Payer: Aetna Commercial |
$8,753.73
|
| Rate for Payer: Anthem Medicaid |
$3,909.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,867.41
|
| Rate for Payer: Cash Price |
$5,684.24
|
| Rate for Payer: Cigna Commercial |
$9,435.84
|
| Rate for Payer: First Health Commercial |
$10,800.06
|
| Rate for Payer: Humana Commercial |
$9,663.21
|
| Rate for Payer: Humana KY Medicaid |
$3,909.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,949.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,322.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,389.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,410.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,988.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,004.26
|
| Rate for Payer: Ohio Health Group HMO |
$8,526.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,094.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,890.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,844.25
|
| Rate for Payer: PHCS Commercial |
$10,913.74
|
| Rate for Payer: United Healthcare All Payer |
$10,004.26
|
|
|
TIB FULLWDG RK/HK LGN 1-2 15MM
|
Facility
|
OP
|
$11,258.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,377.51 |
| Max. Negotiated Rate |
$10,808.04 |
| Rate for Payer: Aetna Commercial |
$8,668.95
|
| Rate for Payer: Anthem Medicaid |
$3,871.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,781.54
|
| Rate for Payer: Cash Price |
$5,629.19
|
| Rate for Payer: Cigna Commercial |
$9,344.46
|
| Rate for Payer: First Health Commercial |
$10,695.46
|
| Rate for Payer: Humana Commercial |
$9,569.62
|
| Rate for Payer: Humana KY Medicaid |
$3,871.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,911.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,231.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,308.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,377.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,949.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,907.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,443.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,006.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,794.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,768.28
|
| Rate for Payer: PHCS Commercial |
$10,808.04
|
| Rate for Payer: United Healthcare All Payer |
$9,907.37
|
|
|
TIB FULLWDG RK/HK LGN 1-2 15MM
|
Facility
|
IP
|
$11,258.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,377.51 |
| Max. Negotiated Rate |
$10,808.04 |
| Rate for Payer: Aetna Commercial |
$8,668.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,781.54
|
| Rate for Payer: Cash Price |
$5,629.19
|
| Rate for Payer: Cigna Commercial |
$9,344.46
|
| Rate for Payer: First Health Commercial |
$10,695.46
|
| Rate for Payer: Humana Commercial |
$9,569.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,231.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,308.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,377.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,907.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,443.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,006.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,794.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,768.28
|
| Rate for Payer: PHCS Commercial |
$10,808.04
|
| Rate for Payer: United Healthcare All Payer |
$9,907.37
|
|
|
TIB FULLWDG RK/HK LGN 3-4 10MM
|
Facility
|
OP
|
$11,368.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,410.54 |
| Max. Negotiated Rate |
$10,913.74 |
| Rate for Payer: Aetna Commercial |
$8,753.73
|
| Rate for Payer: Anthem Medicaid |
$3,909.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,867.41
|
| Rate for Payer: Cash Price |
$5,684.24
|
| Rate for Payer: Cigna Commercial |
$9,435.84
|
| Rate for Payer: First Health Commercial |
$10,800.06
|
| Rate for Payer: Humana Commercial |
$9,663.21
|
| Rate for Payer: Humana KY Medicaid |
$3,909.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,949.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,322.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,389.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,410.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,988.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,004.26
|
| Rate for Payer: Ohio Health Group HMO |
$8,526.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,094.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,890.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,844.25
|
| Rate for Payer: PHCS Commercial |
$10,913.74
|
| Rate for Payer: United Healthcare All Payer |
$10,004.26
|
|
|
TIB FULLWDG RK/HK LGN 3-4 10MM
|
Facility
|
IP
|
$11,368.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,410.54 |
| Max. Negotiated Rate |
$10,913.74 |
| Rate for Payer: Aetna Commercial |
$8,753.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,867.41
|
| Rate for Payer: Cash Price |
$5,684.24
|
| Rate for Payer: Cigna Commercial |
$9,435.84
|
| Rate for Payer: First Health Commercial |
$10,800.06
|
| Rate for Payer: Humana Commercial |
$9,663.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,322.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,389.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,410.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,004.26
|
| Rate for Payer: Ohio Health Group HMO |
$8,526.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,094.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,890.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,844.25
|
| Rate for Payer: PHCS Commercial |
$10,913.74
|
| Rate for Payer: United Healthcare All Payer |
$10,004.26
|
|
|
TIB FULLWDG RK/HK LGN 3-4 15MM
|
Facility
|
IP
|
$11,258.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,377.51 |
| Max. Negotiated Rate |
$10,808.04 |
| Rate for Payer: Aetna Commercial |
$8,668.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,781.54
|
| Rate for Payer: Cash Price |
$5,629.19
|
| Rate for Payer: Cigna Commercial |
$9,344.46
|
| Rate for Payer: First Health Commercial |
$10,695.46
|
| Rate for Payer: Humana Commercial |
$9,569.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,231.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,308.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,377.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,907.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,443.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,006.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,794.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,768.28
|
| Rate for Payer: PHCS Commercial |
$10,808.04
|
| Rate for Payer: United Healthcare All Payer |
$9,907.37
|
|
|
TIB FULLWDG RK/HK LGN 3-4 15MM
|
Facility
|
OP
|
$11,258.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,377.51 |
| Max. Negotiated Rate |
$10,808.04 |
| Rate for Payer: Aetna Commercial |
$8,668.95
|
| Rate for Payer: Anthem Medicaid |
$3,871.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,781.54
|
| Rate for Payer: Cash Price |
$5,629.19
|
| Rate for Payer: Cigna Commercial |
$9,344.46
|
| Rate for Payer: First Health Commercial |
$10,695.46
|
| Rate for Payer: Humana Commercial |
$9,569.62
|
| Rate for Payer: Humana KY Medicaid |
$3,871.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,911.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,231.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,308.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,377.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,949.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,907.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,443.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,006.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,794.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,768.28
|
| Rate for Payer: PHCS Commercial |
$10,808.04
|
| Rate for Payer: United Healthcare All Payer |
$9,907.37
|
|
|
TIB FULLWDG RK/HK LGN 5-6 10MM
|
Facility
|
IP
|
$11,922.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,576.80 |
| Max. Negotiated Rate |
$11,445.74 |
| Rate for Payer: Aetna Commercial |
$9,180.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,299.67
|
| Rate for Payer: Cash Price |
$5,961.32
|
| Rate for Payer: Cigna Commercial |
$9,895.80
|
| Rate for Payer: First Health Commercial |
$11,326.52
|
| Rate for Payer: Humana Commercial |
$10,134.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,776.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,798.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,576.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,491.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,941.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,538.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,372.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,226.63
|
| Rate for Payer: PHCS Commercial |
$11,445.74
|
| Rate for Payer: United Healthcare All Payer |
$10,491.93
|
|
|
TIB FULLWDG RK/HK LGN 5-6 10MM
|
Facility
|
OP
|
$11,922.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,576.80 |
| Max. Negotiated Rate |
$11,445.74 |
| Rate for Payer: Aetna Commercial |
$9,180.44
|
| Rate for Payer: Anthem Medicaid |
$4,100.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,299.67
|
| Rate for Payer: Cash Price |
$5,961.32
|
| Rate for Payer: Cigna Commercial |
$9,895.80
|
| Rate for Payer: First Health Commercial |
$11,326.52
|
| Rate for Payer: Humana Commercial |
$10,134.25
|
| Rate for Payer: Humana KY Medicaid |
$4,100.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,141.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,776.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,798.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,576.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,182.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,491.93
|
| Rate for Payer: Ohio Health Group HMO |
$8,941.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,538.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,372.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,226.63
|
| Rate for Payer: PHCS Commercial |
$11,445.74
|
| Rate for Payer: United Healthcare All Payer |
$10,491.93
|
|
|
TIB FULLWDG RK/HK LGN 5-6 15MM
|
Facility
|
IP
|
$11,258.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,377.51 |
| Max. Negotiated Rate |
$10,808.04 |
| Rate for Payer: Aetna Commercial |
$8,668.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,781.54
|
| Rate for Payer: Cash Price |
$5,629.19
|
| Rate for Payer: Cigna Commercial |
$9,344.46
|
| Rate for Payer: First Health Commercial |
$10,695.46
|
| Rate for Payer: Humana Commercial |
$9,569.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,231.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,308.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,377.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,907.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,443.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,006.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,794.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,768.28
|
| Rate for Payer: PHCS Commercial |
$10,808.04
|
| Rate for Payer: United Healthcare All Payer |
$9,907.37
|
|
|
TIB FULLWDG RK/HK LGN 5-6 15MM
|
Facility
|
OP
|
$11,258.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,377.51 |
| Max. Negotiated Rate |
$10,808.04 |
| Rate for Payer: Aetna Commercial |
$8,668.95
|
| Rate for Payer: Anthem Medicaid |
$3,871.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,781.54
|
| Rate for Payer: Cash Price |
$5,629.19
|
| Rate for Payer: Cigna Commercial |
$9,344.46
|
| Rate for Payer: First Health Commercial |
$10,695.46
|
| Rate for Payer: Humana Commercial |
$9,569.62
|
| Rate for Payer: Humana KY Medicaid |
$3,871.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,911.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,231.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,308.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,377.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,949.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,907.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,443.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,006.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,794.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,768.28
|
| Rate for Payer: PHCS Commercial |
$10,808.04
|
| Rate for Payer: United Healthcare All Payer |
$9,907.37
|
|
|
TIB FULLWDG RK/HK LGN 7-8 10MM
|
Facility
|
OP
|
$9,821.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,946.55 |
| Max. Negotiated Rate |
$9,428.98 |
| Rate for Payer: Aetna Commercial |
$7,562.82
|
| Rate for Payer: Anthem Medicaid |
$3,377.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,661.04
|
| Rate for Payer: Cash Price |
$4,910.92
|
| Rate for Payer: Cigna Commercial |
$8,152.14
|
| Rate for Payer: First Health Commercial |
$9,330.76
|
| Rate for Payer: Humana Commercial |
$8,348.57
|
| Rate for Payer: Humana KY Medicaid |
$3,377.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,412.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,053.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,248.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,946.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,643.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,366.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,857.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,545.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,777.08
|
| Rate for Payer: PHCS Commercial |
$9,428.98
|
| Rate for Payer: United Healthcare All Payer |
$8,643.23
|
|
|
TIB FULLWDG RK/HK LGN 7-8 10MM
|
Facility
|
IP
|
$9,821.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,946.55 |
| Max. Negotiated Rate |
$9,428.98 |
| Rate for Payer: Aetna Commercial |
$7,562.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,661.04
|
| Rate for Payer: Cash Price |
$4,910.92
|
| Rate for Payer: Cigna Commercial |
$8,152.14
|
| Rate for Payer: First Health Commercial |
$9,330.76
|
| Rate for Payer: Humana Commercial |
$8,348.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,053.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,248.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,946.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,643.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,366.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,857.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,545.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,777.08
|
| Rate for Payer: PHCS Commercial |
$9,428.98
|
| Rate for Payer: United Healthcare All Payer |
$8,643.23
|
|
|
TIB FULLWDG RK/HK LGN 7-8 15MM
|
Facility
|
OP
|
$9,821.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,946.55 |
| Max. Negotiated Rate |
$9,428.98 |
| Rate for Payer: Aetna Commercial |
$7,562.82
|
| Rate for Payer: Anthem Medicaid |
$3,377.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,661.04
|
| Rate for Payer: Cash Price |
$4,910.92
|
| Rate for Payer: Cigna Commercial |
$8,152.14
|
| Rate for Payer: First Health Commercial |
$9,330.76
|
| Rate for Payer: Humana Commercial |
$8,348.57
|
| Rate for Payer: Humana KY Medicaid |
$3,377.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,412.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,053.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,248.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,946.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,643.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,366.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,857.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,545.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,777.08
|
| Rate for Payer: PHCS Commercial |
$9,428.98
|
| Rate for Payer: United Healthcare All Payer |
$8,643.23
|
|
|
TIB FULLWDG RK/HK LGN 7-8 15MM
|
Facility
|
IP
|
$9,821.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,946.55 |
| Max. Negotiated Rate |
$9,428.98 |
| Rate for Payer: Aetna Commercial |
$7,562.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,661.04
|
| Rate for Payer: Cash Price |
$4,910.92
|
| Rate for Payer: Cigna Commercial |
$8,152.14
|
| Rate for Payer: First Health Commercial |
$9,330.76
|
| Rate for Payer: Humana Commercial |
$8,348.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,053.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,248.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,946.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,643.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,366.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,857.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,545.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,777.08
|
| Rate for Payer: PHCS Commercial |
$9,428.98
|
| Rate for Payer: United Healthcare All Payer |
$8,643.23
|
|
|
TIB GNS II CMT W/O TAPER SZ7 L
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
