|
TIBIA PSN CMT 5 DEG SZ D R
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ D R
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ E L
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ E L
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ E R
|
Facility
|
OP
|
$8,392.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,517.86 |
| Max. Negotiated Rate |
$8,057.16 |
| Rate for Payer: Aetna Commercial |
$6,462.52
|
| Rate for Payer: Anthem Medicaid |
$2,886.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,546.45
|
| Rate for Payer: Cash Price |
$4,196.44
|
| Rate for Payer: Cigna Commercial |
$6,966.09
|
| Rate for Payer: First Health Commercial |
$7,973.24
|
| Rate for Payer: Humana Commercial |
$7,133.95
|
| Rate for Payer: Humana KY Medicaid |
$2,886.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,915.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,882.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,193.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,517.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,944.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,385.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,294.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,714.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,301.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,791.09
|
| Rate for Payer: PHCS Commercial |
$8,057.16
|
| Rate for Payer: United Healthcare All Payer |
$7,385.73
|
|
|
TIBIA PSN CMT 5 DEG SZ E R
|
Facility
|
IP
|
$8,392.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,517.86 |
| Max. Negotiated Rate |
$8,057.16 |
| Rate for Payer: Aetna Commercial |
$6,462.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,546.45
|
| Rate for Payer: Cash Price |
$4,196.44
|
| Rate for Payer: Cigna Commercial |
$6,966.09
|
| Rate for Payer: First Health Commercial |
$7,973.24
|
| Rate for Payer: Humana Commercial |
$7,133.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,882.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,193.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,517.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,385.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,294.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,714.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,301.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,791.09
|
| Rate for Payer: PHCS Commercial |
$8,057.16
|
| Rate for Payer: United Healthcare All Payer |
$7,385.73
|
|
|
TIBIA PSN CMT 5 DEG SZ F L
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ F L
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ F R
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ F R
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ G L
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ G L
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ G R
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ G R
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ J L
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ J L
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ J R
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA PSN CMT 5 DEG SZ J R
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
TIBIA TWO-PEG LT SZ E
|
Facility
|
IP
|
$11,170.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,351.09 |
| Max. Negotiated Rate |
$10,723.49 |
| Rate for Payer: Aetna Commercial |
$8,601.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,712.83
|
| Rate for Payer: Cash Price |
$5,585.15
|
| Rate for Payer: Cigna Commercial |
$9,271.35
|
| Rate for Payer: First Health Commercial |
$10,611.78
|
| Rate for Payer: Humana Commercial |
$9,494.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,159.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,243.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,351.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,829.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,377.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,936.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,718.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,707.51
|
| Rate for Payer: PHCS Commercial |
$10,723.49
|
| Rate for Payer: United Healthcare All Payer |
$9,829.86
|
|
|
TIBIA TWO-PEG LT SZ E
|
Facility
|
OP
|
$11,170.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,351.09 |
| Max. Negotiated Rate |
$10,723.49 |
| Rate for Payer: Aetna Commercial |
$8,601.13
|
| Rate for Payer: Anthem Medicaid |
$3,841.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,712.83
|
| Rate for Payer: Cash Price |
$5,585.15
|
| Rate for Payer: Cigna Commercial |
$9,271.35
|
| Rate for Payer: First Health Commercial |
$10,611.78
|
| Rate for Payer: Humana Commercial |
$9,494.75
|
| Rate for Payer: Humana KY Medicaid |
$3,841.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,880.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,159.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,243.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,351.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,918.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,829.86
|
| Rate for Payer: Ohio Health Group HMO |
$8,377.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,936.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,718.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,707.51
|
| Rate for Payer: PHCS Commercial |
$10,723.49
|
| Rate for Payer: United Healthcare All Payer |
$9,829.86
|
|
|
TIB INSRTJRNY SZ3-4 12MM LM/RL
|
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
|
|
|
TIB INSRTJRNY SZ3-4 12MM LM/RL
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
TIB INSRTJRNY SZ3-4 12MM RM/LL
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
TIB INSRTJRNY SZ3-4 12MM RM/LL
|
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
|
|
|
TIB INSRTJRNY SZ3-4 14MM LM/RL
|
Facility
|
IP
|
$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 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: 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: 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
|
|
