|
TIS TRNFR ADDL 30 SQ CM(T
|
Facility
|
IP
|
$2,966.63
|
|
|
Service Code
|
HCPCS 14302
|
| Hospital Charge Code |
761T0170
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$889.99 |
| Max. Negotiated Rate |
$2,847.96 |
| Rate for Payer: Aetna Commercial |
$2,284.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,313.97
|
| Rate for Payer: Cash Price |
$1,483.32
|
| Rate for Payer: Cigna Commercial |
$2,462.30
|
| Rate for Payer: First Health Commercial |
$2,818.30
|
| Rate for Payer: Humana Commercial |
$2,521.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,432.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,189.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$889.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,610.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,224.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,373.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,580.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,046.97
|
| Rate for Payer: PHCS Commercial |
$2,847.96
|
| Rate for Payer: United Healthcare All Payer |
$2,610.63
|
|
|
TIS TRNFR ANY 30.1-60 SQ CM
|
Facility
|
IP
|
$7,290.93
|
|
|
Service Code
|
HCPCS 14301
|
| Hospital Charge Code |
76100169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,187.28 |
| Max. Negotiated Rate |
$6,999.29 |
| Rate for Payer: Aetna Commercial |
$5,614.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,686.93
|
| Rate for Payer: Cash Price |
$3,645.47
|
| Rate for Payer: Cigna Commercial |
$6,051.47
|
| Rate for Payer: First Health Commercial |
$6,926.38
|
| Rate for Payer: Humana Commercial |
$6,197.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,978.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,380.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,416.02
|
| Rate for Payer: Ohio Health Group HMO |
$5,468.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,832.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,343.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.74
|
| Rate for Payer: PHCS Commercial |
$6,999.29
|
| Rate for Payer: United Healthcare All Payer |
$6,416.02
|
|
|
TIS TRNFR ANY 30.1-60 SQ CM
|
Facility
|
OP
|
$7,290.93
|
|
|
Service Code
|
HCPCS 14301
|
| Hospital Charge Code |
76100169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,507.35 |
| Max. Negotiated Rate |
$6,999.29 |
| Rate for Payer: Aetna Commercial |
$5,614.02
|
| Rate for Payer: Anthem Medicaid |
$2,507.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,686.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$3,645.47
|
| Rate for Payer: Cash Price |
$3,645.47
|
| Rate for Payer: Cigna Commercial |
$6,051.47
|
| Rate for Payer: First Health Commercial |
$6,926.38
|
| Rate for Payer: Humana Commercial |
$6,197.29
|
| Rate for Payer: Humana KY Medicaid |
$2,507.35
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,532.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,978.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,380.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,557.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,416.02
|
| Rate for Payer: Ohio Health Group HMO |
$5,468.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,832.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,343.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.74
|
| Rate for Payer: PHCS Commercial |
$6,999.29
|
| Rate for Payer: United Healthcare All Payer |
$6,416.02
|
|
|
TIS TRNFR ANY 30.1-60 SQ CM
|
Professional
|
Both
|
$7,290.93
|
|
|
Service Code
|
HCPCS 14301
|
| Hospital Charge Code |
76100169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.71 |
| Max. Negotiated Rate |
$4,374.56 |
| Rate for Payer: Aetna Commercial |
$1,366.41
|
| Rate for Payer: Ambetter Exchange |
$818.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$440.71
|
| Rate for Payer: Anthem Medicaid |
$758.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$818.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$818.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$981.68
|
| Rate for Payer: Cash Price |
$3,645.47
|
| Rate for Payer: Cash Price |
$3,645.47
|
| Rate for Payer: Cigna Commercial |
$1,381.65
|
| Rate for Payer: Healthspan PPO |
$1,008.01
|
| Rate for Payer: Humana Medicaid |
$758.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,147.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$818.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$818.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$773.98
|
| Rate for Payer: Molina Healthcare Passport |
$758.80
|
| Rate for Payer: Multiplan PHCS |
$4,374.56
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,063.49
|
| Rate for Payer: UHCCP Medicaid |
$462.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$766.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$818.07
|
|
|
TIS TRNFR ANY 30.1-60 SQ CM(P
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 14301
|
| Hospital Charge Code |
761P0169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.71 |
| Max. Negotiated Rate |
$1,381.65 |
| Rate for Payer: Aetna Commercial |
$1,366.41
|
| Rate for Payer: Ambetter Exchange |
$818.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$440.71
|
| Rate for Payer: Anthem Medicaid |
$758.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$818.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$818.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$981.68
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,381.65
|
| Rate for Payer: Healthspan PPO |
$1,008.01
|
| Rate for Payer: Humana Medicaid |
$758.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,147.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$818.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$818.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$773.98
|
| Rate for Payer: Molina Healthcare Passport |
$758.80
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,063.49
|
| Rate for Payer: UHCCP Medicaid |
$462.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$766.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$818.07
|
|
|
TIS TRNFR ANY 30.1-60 SQ CM(T
|
Facility
|
IP
|
$5,740.93
|
|
|
Service Code
|
HCPCS 14301
|
| Hospital Charge Code |
761T0169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,722.28 |
| Max. Negotiated Rate |
$5,511.29 |
| Rate for Payer: Aetna Commercial |
$4,420.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,477.93
|
| Rate for Payer: Cash Price |
$2,870.47
|
| Rate for Payer: Cigna Commercial |
$4,764.97
|
| Rate for Payer: First Health Commercial |
$5,453.88
|
| Rate for Payer: Humana Commercial |
$4,879.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,707.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,236.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,052.02
|
| Rate for Payer: Ohio Health Group HMO |
$4,305.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,592.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,994.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,961.24
|
| Rate for Payer: PHCS Commercial |
$5,511.29
|
| Rate for Payer: United Healthcare All Payer |
$5,052.02
|
|
|
TIS TRNFR ANY 30.1-60 SQ CM(T
|
Facility
|
OP
|
$5,740.93
|
|
|
Service Code
|
HCPCS 14301
|
| Hospital Charge Code |
761T0169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,974.31 |
| Max. Negotiated Rate |
$5,511.29 |
| Rate for Payer: Aetna Commercial |
$4,420.52
|
| Rate for Payer: Anthem Medicaid |
$1,974.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,477.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$2,870.47
|
| Rate for Payer: Cash Price |
$2,870.47
|
| Rate for Payer: Cigna Commercial |
$4,764.97
|
| Rate for Payer: First Health Commercial |
$5,453.88
|
| Rate for Payer: Humana Commercial |
$4,879.79
|
| Rate for Payer: Humana KY Medicaid |
$1,974.31
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,994.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,707.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,236.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,013.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,052.02
|
| Rate for Payer: Ohio Health Group HMO |
$4,305.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,592.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,994.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,961.24
|
| Rate for Payer: PHCS Commercial |
$5,511.29
|
| Rate for Payer: United Healthcare All Payer |
$5,052.02
|
|
|
TIS TRNFR E/N/E/L10.1-30SQCM
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 14061
|
| Hospital Charge Code |
76102692
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$445.57 |
| Max. Negotiated Rate |
$1,304.64 |
| Rate for Payer: Aetna Commercial |
$1,204.55
|
| Rate for Payer: Ambetter Exchange |
$767.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$445.57
|
| Rate for Payer: Anthem Medicaid |
$647.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$767.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$767.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$920.51
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,304.64
|
| Rate for Payer: Healthspan PPO |
$1,130.47
|
| Rate for Payer: Humana Medicaid |
$647.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,059.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$767.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$660.27
|
| Rate for Payer: Molina Healthcare Passport |
$647.32
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$997.22
|
| Rate for Payer: UHCCP Medicaid |
$467.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$653.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$767.09
|
|
|
TIS TRNFR S/A/L 10.1-30 SQCM
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
76102598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.39 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$903.21
|
| Rate for Payer: Anthem Medicaid |
$403.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$914.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$973.59
|
| Rate for Payer: First Health Commercial |
$1,114.35
|
| Rate for Payer: Humana Commercial |
$997.05
|
| Rate for Payer: Humana KY Medicaid |
$403.39
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$407.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$961.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$865.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.24
|
| Rate for Payer: Ohio Health Group HMO |
$879.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,020.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.37
|
| Rate for Payer: PHCS Commercial |
$1,126.08
|
| Rate for Payer: United Healthcare All Payer |
$1,032.24
|
|
|
TIS TRNFR S/A/L 10.1-30 SQCM
|
Professional
|
Both
|
$1,173.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
76102598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.35 |
| Max. Negotiated Rate |
$1,103.60 |
| Rate for Payer: Aetna Commercial |
$1,043.99
|
| Rate for Payer: Ambetter Exchange |
$666.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$358.35
|
| Rate for Payer: Anthem Medicaid |
$464.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$666.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$666.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$799.62
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,103.60
|
| Rate for Payer: Healthspan PPO |
$971.29
|
| Rate for Payer: Humana Medicaid |
$464.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$914.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$666.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$666.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$473.64
|
| Rate for Payer: Molina Healthcare Passport |
$464.35
|
| Rate for Payer: Multiplan PHCS |
$703.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$866.25
|
| Rate for Payer: UHCCP Medicaid |
$376.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$468.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$666.35
|
|
|
TIS TRNFR S/A/L 10.1-30 SQCM
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
76102598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.90 |
| Max. Negotiated Rate |
$1,126.08 |
| Rate for Payer: Aetna Commercial |
$903.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$914.94
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$973.59
|
| Rate for Payer: First Health Commercial |
$1,114.35
|
| Rate for Payer: Humana Commercial |
$997.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$961.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$865.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.24
|
| Rate for Payer: Ohio Health Group HMO |
$879.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,020.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.37
|
| Rate for Payer: PHCS Commercial |
$1,126.08
|
| Rate for Payer: United Healthcare All Payer |
$1,032.24
|
|
|
TIS TRNFR S/A/L 10.1-30 SQCM
|
Professional
|
Both
|
$1,173.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
761P2598
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.35 |
| Max. Negotiated Rate |
$1,103.60 |
| Rate for Payer: Aetna Commercial |
$1,043.99
|
| Rate for Payer: Ambetter Exchange |
$666.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$358.35
|
| Rate for Payer: Anthem Medicaid |
$464.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$666.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$666.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$799.62
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,103.60
|
| Rate for Payer: Healthspan PPO |
$971.29
|
| Rate for Payer: Humana Medicaid |
$464.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$914.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$666.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$666.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$473.64
|
| Rate for Payer: Molina Healthcare Passport |
$464.35
|
| Rate for Payer: Multiplan PHCS |
$703.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$866.25
|
| Rate for Payer: UHCCP Medicaid |
$376.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$468.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$666.35
|
|
|
TITAL CHP 100 LEGTH 16 THRD
|
Facility
|
IP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
|
TITAL CHP 100 LEGTH 16 THRD
|
Facility
|
OP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem Medicaid |
$1,149.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Humana KY Medicaid |
$1,149.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,172.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
|
TITAL CHP 105 LEGTH 16 THRD
|
Facility
|
IP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
|
TITAL CHP 105 LEGTH 16 THRD
|
Facility
|
OP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem Medicaid |
$1,149.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Humana KY Medicaid |
$1,149.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,172.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
|
TITAL CHP 110 LEGTH 16 THRD
|
Facility
|
IP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
|
TITAL CHP 110 LEGTH 16 THRD
|
Facility
|
OP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem Medicaid |
$1,149.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Humana KY Medicaid |
$1,149.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,172.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
|
TITAL CHP 115 LEGTH 16 THRD
|
Facility
|
IP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
|
TITAL CHP 115 LEGTH 16 THRD
|
Facility
|
OP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem Medicaid |
$1,149.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Humana KY Medicaid |
$1,149.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,172.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
|
TITAL CHP 120 LEGTH 16 THRD
|
Facility
|
IP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
|
TITAL CHP 120 LEGTH 16 THRD
|
Facility
|
OP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem Medicaid |
$1,149.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Humana KY Medicaid |
$1,149.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,172.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
|
TITAL CHP 125 LEGTH 16 THRD
|
Facility
|
OP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem Medicaid |
$1,149.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Humana KY Medicaid |
$1,149.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,172.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
|
TITAL CHP 125 LEGTH 16 THRD
|
Facility
|
IP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
|
TITAL CHP 130 LEGTH 16 THRD
|
Facility
|
IP
|
$3,341.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,207.90 |
| Rate for Payer: Aetna Commercial |
$2,573.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,606.42
|
| Rate for Payer: Cash Price |
$1,670.78
|
| Rate for Payer: Cigna Commercial |
$2,773.49
|
| Rate for Payer: First Health Commercial |
$3,174.48
|
| Rate for Payer: Humana Commercial |
$2,840.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,740.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,466.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,506.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,907.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.68
|
| Rate for Payer: PHCS Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare All Payer |
$2,940.57
|
|
