|
TIBL PROXOSS 1 PIEC 5CM 11*150
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
TIBL PROXOSS 1 PIEC 5CM 13*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
|
|
|
TIBL PROXOSS 1 PIEC 5CM 13*150
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
TIBL PROXOSS 1 PIEC 5CM 15*150
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
TIBL PROXOSS 1 PIEC 5CM 15*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
|
|
|
TIBL PROXOSS 1 PIEC 7CM 11*150
|
Facility
|
IP
|
$81,447.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,434.26 |
| Max. Negotiated Rate |
$78,189.62 |
| Rate for Payer: Aetna Commercial |
$62,714.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,529.07
|
| Rate for Payer: Cash Price |
$40,723.76
|
| Rate for Payer: Cigna Commercial |
$67,601.44
|
| Rate for Payer: First Health Commercial |
$77,375.14
|
| Rate for Payer: Humana Commercial |
$69,230.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,786.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,108.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,434.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,673.82
|
| Rate for Payer: Ohio Health Group HMO |
$61,085.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,158.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,859.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,198.79
|
| Rate for Payer: PHCS Commercial |
$78,189.62
|
| Rate for Payer: United Healthcare All Payer |
$71,673.82
|
|
|
TIBL PROXOSS 1 PIEC 7CM 11*150
|
Facility
|
OP
|
$81,447.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,434.26 |
| Max. Negotiated Rate |
$78,189.62 |
| Rate for Payer: Aetna Commercial |
$62,714.59
|
| Rate for Payer: Anthem Medicaid |
$28,009.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,529.07
|
| Rate for Payer: Cash Price |
$40,723.76
|
| Rate for Payer: Cigna Commercial |
$67,601.44
|
| Rate for Payer: First Health Commercial |
$77,375.14
|
| Rate for Payer: Humana Commercial |
$69,230.39
|
| Rate for Payer: Humana KY Medicaid |
$28,009.80
|
| Rate for Payer: Kentucky WC Medicaid |
$28,294.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,786.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,108.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,434.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,571.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,673.82
|
| Rate for Payer: Ohio Health Group HMO |
$61,085.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,158.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,859.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,198.79
|
| Rate for Payer: PHCS Commercial |
$78,189.62
|
| Rate for Payer: United Healthcare All Payer |
$71,673.82
|
|
|
TIBL PROXOSS 1 PIEC 7CM 13*150
|
Facility
|
OP
|
$81,447.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,434.26 |
| Max. Negotiated Rate |
$78,189.62 |
| Rate for Payer: Aetna Commercial |
$62,714.59
|
| Rate for Payer: Anthem Medicaid |
$28,009.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,529.07
|
| Rate for Payer: Cash Price |
$40,723.76
|
| Rate for Payer: Cigna Commercial |
$67,601.44
|
| Rate for Payer: First Health Commercial |
$77,375.14
|
| Rate for Payer: Humana Commercial |
$69,230.39
|
| Rate for Payer: Humana KY Medicaid |
$28,009.80
|
| Rate for Payer: Kentucky WC Medicaid |
$28,294.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,786.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,108.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,434.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,571.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,673.82
|
| Rate for Payer: Ohio Health Group HMO |
$61,085.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,158.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,859.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,198.79
|
| Rate for Payer: PHCS Commercial |
$78,189.62
|
| Rate for Payer: United Healthcare All Payer |
$71,673.82
|
|
|
TIBL PROXOSS 1 PIEC 7CM 13*150
|
Facility
|
IP
|
$81,447.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,434.26 |
| Max. Negotiated Rate |
$78,189.62 |
| Rate for Payer: Aetna Commercial |
$62,714.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,529.07
|
| Rate for Payer: Cash Price |
$40,723.76
|
| Rate for Payer: Cigna Commercial |
$67,601.44
|
| Rate for Payer: First Health Commercial |
$77,375.14
|
| Rate for Payer: Humana Commercial |
$69,230.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,786.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,108.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,434.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,673.82
|
| Rate for Payer: Ohio Health Group HMO |
$61,085.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,158.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,859.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,198.79
|
| Rate for Payer: PHCS Commercial |
$78,189.62
|
| Rate for Payer: United Healthcare All Payer |
$71,673.82
|
|
|
TIBL PROXOSS 1 PIEC 7CM 15*150
|
Facility
|
IP
|
$81,447.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,434.26 |
| Max. Negotiated Rate |
$78,189.62 |
| Rate for Payer: Aetna Commercial |
$62,714.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,529.07
|
| Rate for Payer: Cash Price |
$40,723.76
|
| Rate for Payer: Cigna Commercial |
$67,601.44
|
| Rate for Payer: First Health Commercial |
$77,375.14
|
| Rate for Payer: Humana Commercial |
$69,230.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,786.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,108.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,434.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,673.82
|
| Rate for Payer: Ohio Health Group HMO |
$61,085.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,158.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,859.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,198.79
|
| Rate for Payer: PHCS Commercial |
$78,189.62
|
| Rate for Payer: United Healthcare All Payer |
$71,673.82
|
|
|
TIBL PROXOSS 1 PIEC 7CM 15*150
|
Facility
|
OP
|
$81,447.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,434.26 |
| Max. Negotiated Rate |
$78,189.62 |
| Rate for Payer: Aetna Commercial |
$62,714.59
|
| Rate for Payer: Anthem Medicaid |
$28,009.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,529.07
|
| Rate for Payer: Cash Price |
$40,723.76
|
| Rate for Payer: Cigna Commercial |
$67,601.44
|
| Rate for Payer: First Health Commercial |
$77,375.14
|
| Rate for Payer: Humana Commercial |
$69,230.39
|
| Rate for Payer: Humana KY Medicaid |
$28,009.80
|
| Rate for Payer: Kentucky WC Medicaid |
$28,294.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,786.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,108.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,434.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,571.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,673.82
|
| Rate for Payer: Ohio Health Group HMO |
$61,085.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,158.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,859.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,198.79
|
| Rate for Payer: PHCS Commercial |
$78,189.62
|
| Rate for Payer: United Healthcare All Payer |
$71,673.82
|
|
|
TIB OFFSET COUP W/SLV G11 2MM
|
Facility
|
OP
|
$9,631.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,889.34 |
| Max. Negotiated Rate |
$9,245.89 |
| Rate for Payer: Aetna Commercial |
$7,415.98
|
| Rate for Payer: Anthem Medicaid |
$3,312.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,512.29
|
| Rate for Payer: Cash Price |
$4,815.57
|
| Rate for Payer: Cigna Commercial |
$7,993.85
|
| Rate for Payer: First Health Commercial |
$9,149.58
|
| Rate for Payer: Humana Commercial |
$8,186.47
|
| Rate for Payer: Humana KY Medicaid |
$3,312.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,345.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,897.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,107.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,889.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,378.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,475.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,223.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,704.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,379.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,645.49
|
| Rate for Payer: PHCS Commercial |
$9,245.89
|
| Rate for Payer: United Healthcare All Payer |
$8,475.40
|
|
|
TIB OFFSET COUP W/SLV G11 2MM
|
Facility
|
IP
|
$9,631.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,889.34 |
| Max. Negotiated Rate |
$9,245.89 |
| Rate for Payer: Aetna Commercial |
$7,415.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,512.29
|
| Rate for Payer: Cash Price |
$4,815.57
|
| Rate for Payer: Cigna Commercial |
$7,993.85
|
| Rate for Payer: First Health Commercial |
$9,149.58
|
| Rate for Payer: Humana Commercial |
$8,186.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,897.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,107.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,889.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,475.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,223.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,704.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,379.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,645.49
|
| Rate for Payer: PHCS Commercial |
$9,245.89
|
| Rate for Payer: United Healthcare All Payer |
$8,475.40
|
|
|
TIB OFFSET COUP W/SLV G11 4MM
|
Facility
|
OP
|
$9,631.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,889.34 |
| Max. Negotiated Rate |
$9,245.89 |
| Rate for Payer: Aetna Commercial |
$7,415.98
|
| Rate for Payer: Anthem Medicaid |
$3,312.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,512.29
|
| Rate for Payer: Cash Price |
$4,815.57
|
| Rate for Payer: Cigna Commercial |
$7,993.85
|
| Rate for Payer: First Health Commercial |
$9,149.58
|
| Rate for Payer: Humana Commercial |
$8,186.47
|
| Rate for Payer: Humana KY Medicaid |
$3,312.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,345.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,897.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,107.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,889.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,378.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,475.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,223.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,704.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,379.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,645.49
|
| Rate for Payer: PHCS Commercial |
$9,245.89
|
| Rate for Payer: United Healthcare All Payer |
$8,475.40
|
|
|
TIB OFFSET COUP W/SLV G11 4MM
|
Facility
|
IP
|
$9,631.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,889.34 |
| Max. Negotiated Rate |
$9,245.89 |
| Rate for Payer: Aetna Commercial |
$7,415.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,512.29
|
| Rate for Payer: Cash Price |
$4,815.57
|
| Rate for Payer: Cigna Commercial |
$7,993.85
|
| Rate for Payer: First Health Commercial |
$9,149.58
|
| Rate for Payer: Humana Commercial |
$8,186.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,897.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,107.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,889.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,475.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,223.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,704.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,379.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,645.49
|
| Rate for Payer: PHCS Commercial |
$9,245.89
|
| Rate for Payer: United Healthcare All Payer |
$8,475.40
|
|
|
TIB/PER REVASC ADD-ON
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
HCPCS 37232
|
| Hospital Charge Code |
76101556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.63 |
| Max. Negotiated Rate |
$1,141.24 |
| Rate for Payer: Aetna Commercial |
$347.17
|
| Rate for Payer: Ambetter Exchange |
$185.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.63
|
| Rate for Payer: Anthem Medicaid |
$1,063.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$185.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.79
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$392.92
|
| Rate for Payer: Healthspan PPO |
$1,141.24
|
| Rate for Payer: Humana Medicaid |
$1,063.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$270.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$185.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,085.25
|
| Rate for Payer: Molina Healthcare Passport |
$1,063.97
|
| Rate for Payer: Multiplan PHCS |
$795.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$241.36
|
| Rate for Payer: UHCCP Medicaid |
$109.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,074.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$185.66
|
|
|
TIB/PER REVASC ADD-ON
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
HCPCS 37232
|
| Hospital Charge Code |
76101556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$397.50 |
| Max. Negotiated Rate |
$1,272.00 |
| Rate for Payer: Aetna Commercial |
$1,020.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,033.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$1,099.75
|
| Rate for Payer: First Health Commercial |
$1,258.75
|
| Rate for Payer: Humana Commercial |
$1,126.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,086.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$977.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$397.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,166.00
|
| Rate for Payer: Ohio Health Group HMO |
$993.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,060.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$914.25
|
| Rate for Payer: PHCS Commercial |
$1,272.00
|
| Rate for Payer: United Healthcare All Payer |
$1,166.00
|
|
|
TIB/PER REVASC ADD-ON
|
Facility
|
OP
|
$1,325.00
|
|
|
Service Code
|
HCPCS 37232
|
| Hospital Charge Code |
76101556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$397.50 |
| Max. Negotiated Rate |
$1,272.00 |
| Rate for Payer: Aetna Commercial |
$1,020.25
|
| Rate for Payer: Anthem Medicaid |
$455.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,033.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$1,099.75
|
| Rate for Payer: First Health Commercial |
$1,258.75
|
| Rate for Payer: Humana Commercial |
$1,126.25
|
| Rate for Payer: Humana KY Medicaid |
$455.67
|
| Rate for Payer: Kentucky WC Medicaid |
$460.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,086.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$977.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$397.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$464.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,166.00
|
| Rate for Payer: Ohio Health Group HMO |
$993.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,060.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$914.25
|
| Rate for Payer: PHCS Commercial |
$1,272.00
|
| Rate for Payer: United Healthcare All Payer |
$1,166.00
|
|
|
TIB/PER REVASC ADD-ON(P
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
HCPCS 37232
|
| Hospital Charge Code |
761P1556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.63 |
| Max. Negotiated Rate |
$1,141.24 |
| Rate for Payer: Aetna Commercial |
$347.17
|
| Rate for Payer: Ambetter Exchange |
$185.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.63
|
| Rate for Payer: Anthem Medicaid |
$1,063.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$185.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.79
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$392.92
|
| Rate for Payer: Healthspan PPO |
$1,141.24
|
| Rate for Payer: Humana Medicaid |
$1,063.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$270.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$185.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,085.25
|
| Rate for Payer: Molina Healthcare Passport |
$1,063.97
|
| Rate for Payer: Multiplan PHCS |
$795.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$241.36
|
| Rate for Payer: UHCCP Medicaid |
$109.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,074.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$185.66
|
|
|
TIB/PER REVASC STENT & ATHE(P
|
Professional
|
Both
|
$13,455.61
|
|
|
Service Code
|
HCPCS 37231
|
| Hospital Charge Code |
761P1555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.81 |
| Max. Negotiated Rate |
$12,514.84 |
| Rate for Payer: Aetna Commercial |
$1,295.94
|
| Rate for Payer: Ambetter Exchange |
$689.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$390.81
|
| Rate for Payer: Anthem Medicaid |
$11,741.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$689.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$689.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$827.92
|
| Rate for Payer: Cash Price |
$6,727.80
|
| Rate for Payer: Cash Price |
$6,727.80
|
| Rate for Payer: Cigna Commercial |
$1,470.21
|
| Rate for Payer: Healthspan PPO |
$12,514.84
|
| Rate for Payer: Humana Medicaid |
$11,741.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,010.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$689.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$689.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$11,975.83
|
| Rate for Payer: Molina Healthcare Passport |
$11,741.01
|
| Rate for Payer: Multiplan PHCS |
$8,073.37
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$896.91
|
| Rate for Payer: UHCCP Medicaid |
$410.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11,858.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$689.93
|
|
|
TIB/PER REVASC STENT & ATHER
|
Facility
|
IP
|
$13,455.61
|
|
|
Service Code
|
HCPCS 37231
|
| Hospital Charge Code |
76101555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,036.68 |
| Max. Negotiated Rate |
$12,917.39 |
| Rate for Payer: Aetna Commercial |
$10,360.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,495.38
|
| Rate for Payer: Cash Price |
$6,727.80
|
| Rate for Payer: Cigna Commercial |
$11,168.16
|
| Rate for Payer: First Health Commercial |
$12,782.83
|
| Rate for Payer: Humana Commercial |
$11,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,033.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,930.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,036.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,840.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,091.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,764.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,706.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.37
|
| Rate for Payer: PHCS Commercial |
$12,917.39
|
| Rate for Payer: United Healthcare All Payer |
$11,840.94
|
|
|
TIB/PER REVASC STENT & ATHER
|
Facility
|
OP
|
$13,455.61
|
|
|
Service Code
|
HCPCS 37231
|
| Hospital Charge Code |
76101555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,627.38 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Aetna Commercial |
$10,360.82
|
| Rate for Payer: Anthem Medicaid |
$4,627.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,495.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| Rate for Payer: Cash Price |
$6,727.80
|
| Rate for Payer: Cash Price |
$6,727.80
|
| Rate for Payer: Cigna Commercial |
$11,168.16
|
| Rate for Payer: First Health Commercial |
$12,782.83
|
| Rate for Payer: Humana Commercial |
$11,437.27
|
| Rate for Payer: Humana KY Medicaid |
$4,627.38
|
| Rate for Payer: Humana Medicare Advantage |
$16,591.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,674.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,033.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,930.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,909.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,720.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,840.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,091.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,764.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,706.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,284.37
|
| Rate for Payer: PHCS Commercial |
$12,917.39
|
| Rate for Payer: United Healthcare All Payer |
$11,840.94
|
|
|
TIB/PER REVASC STENT & ATHER
|
Professional
|
Both
|
$13,455.61
|
|
|
Service Code
|
HCPCS 37231
|
| Hospital Charge Code |
76101555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.81 |
| Max. Negotiated Rate |
$12,514.84 |
| Rate for Payer: Aetna Commercial |
$1,295.94
|
| Rate for Payer: Ambetter Exchange |
$689.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$390.81
|
| Rate for Payer: Anthem Medicaid |
$11,741.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$689.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$689.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$827.92
|
| Rate for Payer: Cash Price |
$6,727.80
|
| Rate for Payer: Cash Price |
$6,727.80
|
| Rate for Payer: Cigna Commercial |
$1,470.21
|
| Rate for Payer: Healthspan PPO |
$12,514.84
|
| Rate for Payer: Humana Medicaid |
$11,741.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,010.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$689.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$689.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$11,975.83
|
| Rate for Payer: Molina Healthcare Passport |
$11,741.01
|
| Rate for Payer: Multiplan PHCS |
$8,073.37
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$896.91
|
| Rate for Payer: UHCCP Medicaid |
$410.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11,858.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$689.93
|
|
|
TIB/PER REVASC STNT & ATHER
|
Professional
|
Both
|
$4,227.53
|
|
|
Service Code
|
HCPCS 37235
|
| Hospital Charge Code |
76101559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.08 |
| Max. Negotiated Rate |
$3,866.70 |
| Rate for Payer: Aetna Commercial |
$674.30
|
| Rate for Payer: Ambetter Exchange |
$347.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$203.08
|
| Rate for Payer: Anthem Medicaid |
$3,619.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$347.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$347.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$417.48
|
| Rate for Payer: Cash Price |
$2,113.76
|
| Rate for Payer: Cash Price |
$2,113.76
|
| Rate for Payer: Cigna Commercial |
$763.86
|
| Rate for Payer: Healthspan PPO |
$3,866.70
|
| Rate for Payer: Humana Medicaid |
$3,619.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$525.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$347.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,691.53
|
| Rate for Payer: Molina Healthcare Passport |
$3,619.15
|
| Rate for Payer: Multiplan PHCS |
$2,536.52
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$452.27
|
| Rate for Payer: UHCCP Medicaid |
$213.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,655.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$347.90
|
|
|
TIB/PER REVASC STNT & ATHER
|
Facility
|
OP
|
$4,227.53
|
|
|
Service Code
|
HCPCS 37235
|
| Hospital Charge Code |
76101559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,268.26 |
| Max. Negotiated Rate |
$4,058.43 |
| Rate for Payer: Aetna Commercial |
$3,255.20
|
| Rate for Payer: Anthem Medicaid |
$1,453.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,297.47
|
| Rate for Payer: Cash Price |
$2,113.76
|
| Rate for Payer: Cigna Commercial |
$3,508.85
|
| Rate for Payer: First Health Commercial |
$4,016.15
|
| Rate for Payer: Humana Commercial |
$3,593.40
|
| Rate for Payer: Humana KY Medicaid |
$1,453.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,468.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,466.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,119.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,268.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,483.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,720.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,170.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,382.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,677.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,917.00
|
| Rate for Payer: PHCS Commercial |
$4,058.43
|
| Rate for Payer: United Healthcare All Payer |
$3,720.23
|
|
