|
UNI EIUS TIB LARGE 10MM LM/RL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB LARGE 10MM LM/RL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB LARGE 10MM RM/LL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB LARGE 10MM RM/LL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB LARGE 12MM LM/RL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB LARGE 12MM LM/RL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB LARGE 12MM RM/LL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB LARGE 12MM RM/LL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB LARGE 8MM LM/RL
|
Facility
|
OP
|
$8,777.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.04 |
| Max. Negotiated Rate |
$8,426.15 |
| Rate for Payer: Aetna Commercial |
$6,758.47
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.25
|
| Rate for Payer: Cash Price |
$4,388.62
|
| Rate for Payer: Cigna Commercial |
$7,285.11
|
| Rate for Payer: First Health Commercial |
$8,338.38
|
| Rate for Payer: Humana Commercial |
$7,460.65
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,720.94
|
| Rate for Payer: PHCS Commercial |
$8,426.15
|
| Rate for Payer: United Healthcare All Payer |
$7,723.97
|
|
|
UNI EIUS TIB LARGE 8MM LM/RL
|
Facility
|
IP
|
$8,777.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.04 |
| Max. Negotiated Rate |
$8,426.15 |
| Rate for Payer: Aetna Commercial |
$6,758.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.25
|
| Rate for Payer: Cash Price |
$4,388.62
|
| Rate for Payer: Cigna Commercial |
$7,285.11
|
| Rate for Payer: First Health Commercial |
$8,338.38
|
| Rate for Payer: Humana Commercial |
$7,460.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,720.94
|
| Rate for Payer: PHCS Commercial |
$8,426.15
|
| Rate for Payer: United Healthcare All Payer |
$7,723.97
|
|
|
UNI EIUS TIB LARGE 8MM RM/LL
|
Facility
|
IP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
|
UNI EIUS TIB LARGE 8MM RM/LL
|
Facility
|
OP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem Medicaid |
$2,756.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Humana KY Medicaid |
$2,756.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,784.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,811.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
|
UNI EIUS TIB LARGE 9MM LM/RL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB LARGE 9MM LM/RL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB LARGE 9MM RM/LL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB LARGE 9MM RM/LL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB MEDIUM 10MM LM/RL
|
Facility
|
IP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
|
UNI EIUS TIB MEDIUM 10MM LM/RL
|
Facility
|
OP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem Medicaid |
$2,756.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Humana KY Medicaid |
$2,756.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,784.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,811.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
|
UNI EIUS TIB MEDIUM 10MM RM/LL
|
Facility
|
IP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
|
UNI EIUS TIB MEDIUM 10MM RM/LL
|
Facility
|
OP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem Medicaid |
$2,756.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Humana KY Medicaid |
$2,756.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,784.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,811.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
|
UNI EIUS TIB MEDIUM 12MM LM/RL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB MEDIUM 12MM LM/RL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB MEDIUM 12MM RM/LL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB MEDIUM 12MM RM/LL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB MEDIUM 8MM LM/RL
|
Facility
|
IP
|
$8,172.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,062.46 |
| Max. Negotiated Rate |
$7,845.89 |
| Rate for Payer: Aetna Commercial |
$6,293.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,374.78
|
| Rate for Payer: Cash Price |
$4,086.40
|
| Rate for Payer: Cigna Commercial |
$6,783.42
|
| Rate for Payer: First Health Commercial |
$7,764.16
|
| Rate for Payer: Humana Commercial |
$6,946.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,701.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,031.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,451.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,192.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,129.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,634.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,062.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,533.57
|
| Rate for Payer: PHCS Commercial |
$7,845.89
|
| Rate for Payer: United Healthcare All Payer |
$7,192.06
|
|
