|
TIBL BEARG VNGD CR LP 20*87/91
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
TIBL BEARG VNGD CR LP 20*87/91
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
TIBL BEARG VNGD CR LP 22*63/67
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
TIBL BEARG VNGD CR LP 22*63/67
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
TIBL BEARG VNGD CR LP 22*71/75
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
TIBL BEARG VNGD CR LP 22*71/75
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
TIBL BEARG VNGD CR LP 22*79/83
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
TIBL BEARG VNGD CR LP 22*79/83
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
TIBL BEARG VNGD CR LP 24*63/67
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
TIBL BEARG VNGD CR LP 24*63/67
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
TIBL BEARG VNGD CR LP 24*79/83
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
TIBL BEARG VNGD CR LP 24*79/83
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
TIBL BLCK AUG RS 10*47/51 UNIV
|
Facility
|
OP
|
$8,680.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.26 |
| Max. Negotiated Rate |
$8,333.63 |
| Rate for Payer: Aetna Commercial |
$6,684.26
|
| Rate for Payer: Anthem Medicaid |
$2,985.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.07
|
| Rate for Payer: Cash Price |
$4,340.43
|
| Rate for Payer: Cigna Commercial |
$7,205.11
|
| Rate for Payer: First Health Commercial |
$8,246.82
|
| Rate for Payer: Humana Commercial |
$7,378.73
|
| Rate for Payer: Humana KY Medicaid |
$2,985.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,015.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,045.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,944.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,552.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,989.79
|
| Rate for Payer: PHCS Commercial |
$8,333.63
|
| Rate for Payer: United Healthcare All Payer |
$7,639.16
|
|
|
TIBL BLCK AUG RS 10*47/51 UNIV
|
Facility
|
IP
|
$8,680.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.26 |
| Max. Negotiated Rate |
$8,333.63 |
| Rate for Payer: Aetna Commercial |
$6,684.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.07
|
| Rate for Payer: Cash Price |
$4,340.43
|
| Rate for Payer: Cigna Commercial |
$7,205.11
|
| Rate for Payer: First Health Commercial |
$8,246.82
|
| Rate for Payer: Humana Commercial |
$7,378.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,944.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,552.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,989.79
|
| Rate for Payer: PHCS Commercial |
$8,333.63
|
| Rate for Payer: United Healthcare All Payer |
$7,639.16
|
|
|
TIBL BLCK AUG RS 10*55/59 UNIV
|
Facility
|
IP
|
$8,680.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.26 |
| Max. Negotiated Rate |
$8,333.63 |
| Rate for Payer: Aetna Commercial |
$6,684.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.07
|
| Rate for Payer: Cash Price |
$4,340.43
|
| Rate for Payer: Cigna Commercial |
$7,205.11
|
| Rate for Payer: First Health Commercial |
$8,246.82
|
| Rate for Payer: Humana Commercial |
$7,378.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,944.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,552.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,989.79
|
| Rate for Payer: PHCS Commercial |
$8,333.63
|
| Rate for Payer: United Healthcare All Payer |
$7,639.16
|
|
|
TIBL BLCK AUG RS 10*55/59 UNIV
|
Facility
|
OP
|
$8,680.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.26 |
| Max. Negotiated Rate |
$8,333.63 |
| Rate for Payer: Aetna Commercial |
$6,684.26
|
| Rate for Payer: Anthem Medicaid |
$2,985.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.07
|
| Rate for Payer: Cash Price |
$4,340.43
|
| Rate for Payer: Cigna Commercial |
$7,205.11
|
| Rate for Payer: First Health Commercial |
$8,246.82
|
| Rate for Payer: Humana Commercial |
$7,378.73
|
| Rate for Payer: Humana KY Medicaid |
$2,985.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,015.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,045.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,944.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,552.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,989.79
|
| Rate for Payer: PHCS Commercial |
$8,333.63
|
| Rate for Payer: United Healthcare All Payer |
$7,639.16
|
|
|
TIBL BLK AUGRS 20*47/51 MR/LL
|
Facility
|
IP
|
$8,680.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.26 |
| Max. Negotiated Rate |
$8,333.63 |
| Rate for Payer: Aetna Commercial |
$6,684.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.07
|
| Rate for Payer: Cash Price |
$4,340.43
|
| Rate for Payer: Cigna Commercial |
$7,205.11
|
| Rate for Payer: First Health Commercial |
$8,246.82
|
| Rate for Payer: Humana Commercial |
$7,378.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,944.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,552.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,989.79
|
| Rate for Payer: PHCS Commercial |
$8,333.63
|
| Rate for Payer: United Healthcare All Payer |
$7,639.16
|
|
|
TIBL BLK AUGRS 20*47/51 MR/LL
|
Facility
|
OP
|
$8,680.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,604.26 |
| Max. Negotiated Rate |
$8,333.63 |
| Rate for Payer: Aetna Commercial |
$6,684.26
|
| Rate for Payer: Anthem Medicaid |
$2,985.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.07
|
| Rate for Payer: Cash Price |
$4,340.43
|
| Rate for Payer: Cigna Commercial |
$7,205.11
|
| Rate for Payer: First Health Commercial |
$8,246.82
|
| Rate for Payer: Humana Commercial |
$7,378.73
|
| Rate for Payer: Humana KY Medicaid |
$2,985.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,015.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,045.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,944.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,552.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,989.79
|
| Rate for Payer: PHCS Commercial |
$8,333.63
|
| Rate for Payer: United Healthcare All Payer |
$7,639.16
|
|
|
TIBL BLK OSS AUG 10*63/67 UNIV
|
Facility
|
IP
|
$9,469.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,840.78 |
| Max. Negotiated Rate |
$9,090.49 |
| Rate for Payer: Aetna Commercial |
$7,291.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,386.02
|
| Rate for Payer: Cash Price |
$4,734.63
|
| Rate for Payer: Cigna Commercial |
$7,859.49
|
| Rate for Payer: First Health Commercial |
$8,995.80
|
| Rate for Payer: Humana Commercial |
$8,048.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,764.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,988.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,840.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,332.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,101.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,575.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,238.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,533.79
|
| Rate for Payer: PHCS Commercial |
$9,090.49
|
| Rate for Payer: United Healthcare All Payer |
$8,332.95
|
|
|
TIBL BLK OSS AUG 10*63/67 UNIV
|
Facility
|
OP
|
$9,469.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,840.78 |
| Max. Negotiated Rate |
$9,090.49 |
| Rate for Payer: Aetna Commercial |
$7,291.33
|
| Rate for Payer: Anthem Medicaid |
$3,256.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,386.02
|
| Rate for Payer: Cash Price |
$4,734.63
|
| Rate for Payer: Cigna Commercial |
$7,859.49
|
| Rate for Payer: First Health Commercial |
$8,995.80
|
| Rate for Payer: Humana Commercial |
$8,048.87
|
| Rate for Payer: Humana KY Medicaid |
$3,256.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,289.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,764.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,988.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,840.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,321.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,332.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,101.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,575.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,238.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,533.79
|
| Rate for Payer: PHCS Commercial |
$9,090.49
|
| Rate for Payer: United Healthcare All Payer |
$8,332.95
|
|
|
TIBL BLK OSS AUG 10*71/75 UNIV
|
Facility
|
OP
|
$8,977.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.11 |
| Max. Negotiated Rate |
$8,617.94 |
| Rate for Payer: Aetna Commercial |
$6,912.31
|
| Rate for Payer: Anthem Medicaid |
$3,087.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,002.08
|
| Rate for Payer: Cash Price |
$4,488.51
|
| Rate for Payer: Cigna Commercial |
$7,450.93
|
| Rate for Payer: First Health Commercial |
$8,528.17
|
| Rate for Payer: Humana Commercial |
$7,630.47
|
| Rate for Payer: Humana KY Medicaid |
$3,087.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,118.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,361.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,625.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,149.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,899.78
|
| Rate for Payer: Ohio Health Group HMO |
$6,732.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,181.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,810.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,194.14
|
| Rate for Payer: PHCS Commercial |
$8,617.94
|
| Rate for Payer: United Healthcare All Payer |
$7,899.78
|
|
|
TIBL BLK OSS AUG 10*71/75 UNIV
|
Facility
|
IP
|
$8,977.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.11 |
| Max. Negotiated Rate |
$8,617.94 |
| Rate for Payer: Aetna Commercial |
$6,912.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,002.08
|
| Rate for Payer: Cash Price |
$4,488.51
|
| Rate for Payer: Cigna Commercial |
$7,450.93
|
| Rate for Payer: First Health Commercial |
$8,528.17
|
| Rate for Payer: Humana Commercial |
$7,630.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,361.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,625.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,899.78
|
| Rate for Payer: Ohio Health Group HMO |
$6,732.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,181.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,810.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,194.14
|
| Rate for Payer: PHCS Commercial |
$8,617.94
|
| Rate for Payer: United Healthcare All Payer |
$7,899.78
|
|
|
TIBL BLK OSS AUG 10*79/83 UNIV
|
Facility
|
OP
|
$9,469.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,840.78 |
| Max. Negotiated Rate |
$9,090.49 |
| Rate for Payer: Aetna Commercial |
$7,291.33
|
| Rate for Payer: Anthem Medicaid |
$3,256.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,386.02
|
| Rate for Payer: Cash Price |
$4,734.63
|
| Rate for Payer: Cigna Commercial |
$7,859.49
|
| Rate for Payer: First Health Commercial |
$8,995.80
|
| Rate for Payer: Humana Commercial |
$8,048.87
|
| Rate for Payer: Humana KY Medicaid |
$3,256.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,289.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,764.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,988.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,840.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,321.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,332.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,101.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,575.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,238.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,533.79
|
| Rate for Payer: PHCS Commercial |
$9,090.49
|
| Rate for Payer: United Healthcare All Payer |
$8,332.95
|
|
|
TIBL BLK OSS AUG 10*79/83 UNIV
|
Facility
|
IP
|
$9,469.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,840.78 |
| Max. Negotiated Rate |
$9,090.49 |
| Rate for Payer: Aetna Commercial |
$7,291.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,386.02
|
| Rate for Payer: Cash Price |
$4,734.63
|
| Rate for Payer: Cigna Commercial |
$7,859.49
|
| Rate for Payer: First Health Commercial |
$8,995.80
|
| Rate for Payer: Humana Commercial |
$8,048.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,764.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,988.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,840.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,332.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,101.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,575.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,238.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,533.79
|
| Rate for Payer: PHCS Commercial |
$9,090.49
|
| Rate for Payer: United Healthcare All Payer |
$8,332.95
|
|
|
TIBL PROXOSS 1 PIEC 5CM 11*150
|
Facility
|
OP
|
$78,232.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,469.82 |
| Max. Negotiated Rate |
$75,103.41 |
| Rate for Payer: Aetna Commercial |
$60,239.19
|
| Rate for Payer: Anthem Medicaid |
$26,904.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,021.52
|
| Rate for Payer: Cash Price |
$39,116.36
|
| Rate for Payer: Cigna Commercial |
$64,933.16
|
| Rate for Payer: First Health Commercial |
$74,321.08
|
| Rate for Payer: Humana Commercial |
$66,497.81
|
| Rate for Payer: Humana KY Medicaid |
$26,904.23
|
| Rate for Payer: Kentucky WC Medicaid |
$27,178.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,150.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,735.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,469.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,444.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,844.79
|
| Rate for Payer: Ohio Health Group HMO |
$58,674.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,586.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,062.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,980.58
|
| Rate for Payer: PHCS Commercial |
$75,103.41
|
| Rate for Payer: United Healthcare All Payer |
$68,844.79
|
|
