|
TRI LM/RL TIB AUG SZ 5 10MM
|
Facility
|
IP
|
$7,690.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.74 |
| Max. Negotiated Rate |
$7,382.66 |
| Rate for Payer: Aetna Commercial |
$5,921.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,998.41
|
| Rate for Payer: Cash Price |
$3,845.14
|
| Rate for Payer: Cigna Commercial |
$6,382.92
|
| Rate for Payer: First Health Commercial |
$7,305.76
|
| Rate for Payer: Humana Commercial |
$6,536.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,306.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,675.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,307.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,767.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,767.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,538.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$999.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,383.98
|
| Rate for Payer: PHCS Commercial |
$7,382.66
|
| Rate for Payer: United Healthcare All Payer |
$6,767.44
|
|
|
TRI LM/RL TIB AUG SZ 5 5MM
|
Facility
|
OP
|
$7,048.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.32 |
| Max. Negotiated Rate |
$6,766.66 |
| Rate for Payer: Aetna Commercial |
$5,427.42
|
| Rate for Payer: Anthem Medicaid |
$2,424.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,497.91
|
| Rate for Payer: Cash Price |
$3,524.30
|
| Rate for Payer: Cigna Commercial |
$5,850.34
|
| Rate for Payer: First Health Commercial |
$6,696.17
|
| Rate for Payer: Humana Commercial |
$5,991.31
|
| Rate for Payer: Humana KY Medicaid |
$2,424.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,448.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,779.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,201.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,114.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,472.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,202.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,286.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,409.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,185.07
|
| Rate for Payer: PHCS Commercial |
$6,766.66
|
| Rate for Payer: United Healthcare All Payer |
$6,202.77
|
|
|
TRI LM/RL TIB AUG SZ 5 5MM
|
Facility
|
IP
|
$7,048.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.32 |
| Max. Negotiated Rate |
$6,766.66 |
| Rate for Payer: Aetna Commercial |
$5,427.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,497.91
|
| Rate for Payer: Cash Price |
$3,524.30
|
| Rate for Payer: Cigna Commercial |
$5,850.34
|
| Rate for Payer: First Health Commercial |
$6,696.17
|
| Rate for Payer: Humana Commercial |
$5,991.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,779.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,201.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,114.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,202.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,286.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,409.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,185.07
|
| Rate for Payer: PHCS Commercial |
$6,766.66
|
| Rate for Payer: United Healthcare All Payer |
$6,202.77
|
|
|
TRI LM/RL TIB AUG SZ 6 10MM
|
Facility
|
OP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem Medicaid |
$2,554.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Humana KY Medicaid |
$2,554.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,580.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,605.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI LM/RL TIB AUG SZ 6 10MM
|
Facility
|
IP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI LM/RL TIB AUG SZ 6 5MM
|
Facility
|
OP
|
$6,674.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$867.71 |
| Max. Negotiated Rate |
$6,407.70 |
| Rate for Payer: Aetna Commercial |
$5,139.51
|
| Rate for Payer: Anthem Medicaid |
$2,295.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,206.26
|
| Rate for Payer: Cash Price |
$3,337.35
|
| Rate for Payer: Cigna Commercial |
$5,539.99
|
| Rate for Payer: First Health Commercial |
$6,340.96
|
| Rate for Payer: Humana Commercial |
$5,673.49
|
| Rate for Payer: Humana KY Medicaid |
$2,295.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,318.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,473.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,925.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,002.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,341.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,873.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,006.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,334.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$867.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,069.15
|
| Rate for Payer: PHCS Commercial |
$6,407.70
|
| Rate for Payer: United Healthcare All Payer |
$5,873.73
|
|
|
TRI LM/RL TIB AUG SZ 6 5MM
|
Facility
|
IP
|
$6,674.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$867.71 |
| Max. Negotiated Rate |
$6,407.70 |
| Rate for Payer: Aetna Commercial |
$5,139.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,206.26
|
| Rate for Payer: Cash Price |
$3,337.35
|
| Rate for Payer: Cigna Commercial |
$5,539.99
|
| Rate for Payer: First Health Commercial |
$6,340.96
|
| Rate for Payer: Humana Commercial |
$5,673.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,473.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,925.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,002.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,873.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,006.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,334.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$867.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,069.15
|
| Rate for Payer: PHCS Commercial |
$6,407.70
|
| Rate for Payer: United Healthcare All Payer |
$5,873.73
|
|
|
TRI LM/RL TIB AUG SZ 7 10MM
|
Facility
|
IP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI LM/RL TIB AUG SZ 7 10MM
|
Facility
|
OP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem Medicaid |
$2,554.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Humana KY Medicaid |
$2,554.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,580.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,605.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI LM/RL TIB AUG SZ 7 5MM
|
Facility
|
OP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem Medicaid |
$2,554.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Humana KY Medicaid |
$2,554.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,580.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,605.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI LM/RL TIB AUG SZ 7 5MM
|
Facility
|
IP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI LM/RL TIB AUG SZ 8 10MM
|
Facility
|
IP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI LM/RL TIB AUG SZ 8 10MM
|
Facility
|
OP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem Medicaid |
$2,554.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Humana KY Medicaid |
$2,554.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,580.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,605.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI LM/RL TIB AUG SZ 8 5MM
|
Facility
|
IP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI LM/RL TIB AUG SZ 8 5MM
|
Facility
|
OP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem Medicaid |
$2,554.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Humana KY Medicaid |
$2,554.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,580.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,605.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRILOCK FEM STEM SZ 0 STD 95MM
|
Facility
|
OP
|
$22,803.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,964.52 |
| Max. Negotiated Rate |
$21,891.83 |
| Rate for Payer: Aetna Commercial |
$17,559.07
|
| Rate for Payer: Anthem Medicaid |
$7,842.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,787.11
|
| Rate for Payer: Cash Price |
$11,402.00
|
| Rate for Payer: Cigna Commercial |
$18,927.31
|
| Rate for Payer: First Health Commercial |
$21,663.79
|
| Rate for Payer: Humana Commercial |
$19,383.39
|
| Rate for Payer: Humana KY Medicaid |
$7,842.29
|
| Rate for Payer: Kentucky WC Medicaid |
$7,922.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,699.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,829.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,841.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,999.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,067.51
|
| Rate for Payer: Ohio Health Group HMO |
$17,102.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,560.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,964.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,069.24
|
| Rate for Payer: PHCS Commercial |
$21,891.83
|
| Rate for Payer: United Healthcare All Payer |
$20,067.51
|
|
|
TRILOCK FEM STEM SZ 0 STD 95MM
|
Facility
|
IP
|
$22,803.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,964.52 |
| Max. Negotiated Rate |
$21,891.83 |
| Rate for Payer: Aetna Commercial |
$17,559.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,787.11
|
| Rate for Payer: Cash Price |
$11,402.00
|
| Rate for Payer: Cigna Commercial |
$18,927.31
|
| Rate for Payer: First Health Commercial |
$21,663.79
|
| Rate for Payer: Humana Commercial |
$19,383.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,699.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,829.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,841.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,067.51
|
| Rate for Payer: Ohio Health Group HMO |
$17,102.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,560.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,964.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,069.24
|
| Rate for Payer: PHCS Commercial |
$21,891.83
|
| Rate for Payer: United Healthcare All Payer |
$20,067.51
|
|
|
TRILOCK FEM STEM SZ 1 STD 97MM
|
Facility
|
OP
|
$22,803.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,964.52 |
| Max. Negotiated Rate |
$21,891.83 |
| Rate for Payer: Aetna Commercial |
$17,559.07
|
| Rate for Payer: Anthem Medicaid |
$7,842.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,787.11
|
| Rate for Payer: Cash Price |
$11,402.00
|
| Rate for Payer: Cigna Commercial |
$18,927.31
|
| Rate for Payer: First Health Commercial |
$21,663.79
|
| Rate for Payer: Humana Commercial |
$19,383.39
|
| Rate for Payer: Humana KY Medicaid |
$7,842.29
|
| Rate for Payer: Kentucky WC Medicaid |
$7,922.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,699.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,829.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,841.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,999.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,067.51
|
| Rate for Payer: Ohio Health Group HMO |
$17,102.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,560.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,964.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,069.24
|
| Rate for Payer: PHCS Commercial |
$21,891.83
|
| Rate for Payer: United Healthcare All Payer |
$20,067.51
|
|
|
TRILOCK FEM STEM SZ 1 STD 97MM
|
Facility
|
IP
|
$22,803.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,964.52 |
| Max. Negotiated Rate |
$21,891.83 |
| Rate for Payer: Aetna Commercial |
$17,559.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,787.11
|
| Rate for Payer: Cash Price |
$11,402.00
|
| Rate for Payer: Cigna Commercial |
$18,927.31
|
| Rate for Payer: First Health Commercial |
$21,663.79
|
| Rate for Payer: Humana Commercial |
$19,383.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,699.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,829.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,841.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,067.51
|
| Rate for Payer: Ohio Health Group HMO |
$17,102.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,560.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,964.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,069.24
|
| Rate for Payer: PHCS Commercial |
$21,891.83
|
| Rate for Payer: United Healthcare All Payer |
$20,067.51
|
|
|
TRIMMING OF NAILS
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
76100093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$25.43
|
| Rate for Payer: Healthspan PPO |
$23.54
|
| Rate for Payer: Humana Medicaid |
$9.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.80
|
| Rate for Payer: Molina Healthcare Passport |
$9.61
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.00
|
| Rate for Payer: UHCCP Medicaid |
$63.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.71
|
|
|
TRIMMING OF NAILS
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
76100093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$61.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$61.90
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$62.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
TRIMMING OF NAILS
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
76100093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
TRIMMING OF NAILS(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
761P0093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$25.43
|
| Rate for Payer: Healthspan PPO |
$23.54
|
| Rate for Payer: Humana Medicaid |
$9.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.80
|
| Rate for Payer: Molina Healthcare Passport |
$9.61
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.71
|
|
|
TRIMMING OF NAILS(T
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
761T0093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.40
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.30
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
TRIMMING OF NAILS(T
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
761T0093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$44.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Humana KY Medicaid |
$44.71
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$45.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.30
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
