|
TRI LM/RL TIB AUG SZ 4 5MM
|
Facility
|
IP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI LM/RL TIB AUG SZ 5 10MM
|
Facility
|
IP
|
$7,890.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,367.08 |
| Max. Negotiated Rate |
$7,574.66 |
| Rate for Payer: Aetna Commercial |
$6,075.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,154.41
|
| Rate for Payer: Cash Price |
$3,945.14
|
| Rate for Payer: Cigna Commercial |
$6,548.92
|
| Rate for Payer: First Health Commercial |
$7,495.76
|
| Rate for Payer: Humana Commercial |
$6,706.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,470.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,823.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,943.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,917.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,312.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,864.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,444.29
|
| Rate for Payer: PHCS Commercial |
$7,574.66
|
| Rate for Payer: United Healthcare All Payer |
$6,943.44
|
|
|
TRI LM/RL TIB AUG SZ 5 10MM
|
Facility
|
OP
|
$7,890.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,367.08 |
| Max. Negotiated Rate |
$7,574.66 |
| Rate for Payer: Aetna Commercial |
$6,075.51
|
| Rate for Payer: Anthem Medicaid |
$2,713.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,154.41
|
| Rate for Payer: Cash Price |
$3,945.14
|
| Rate for Payer: Cigna Commercial |
$6,548.92
|
| Rate for Payer: First Health Commercial |
$7,495.76
|
| Rate for Payer: Humana Commercial |
$6,706.73
|
| Rate for Payer: Humana KY Medicaid |
$2,713.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,741.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,470.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,823.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,767.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,943.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,917.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,312.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,864.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,444.29
|
| Rate for Payer: PHCS Commercial |
$7,574.66
|
| Rate for Payer: United Healthcare All Payer |
$6,943.44
|
|
|
TRI LM/RL TIB AUG SZ 5 5MM
|
Facility
|
IP
|
$6,874.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,062.41 |
| Max. Negotiated Rate |
$6,599.70 |
| Rate for Payer: Aetna Commercial |
$5,293.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,362.26
|
| Rate for Payer: Cash Price |
$3,437.35
|
| Rate for Payer: Cigna Commercial |
$5,705.99
|
| Rate for Payer: First Health Commercial |
$6,530.96
|
| Rate for Payer: Humana Commercial |
$5,843.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,637.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,073.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,062.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,049.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,156.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,499.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,980.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,743.54
|
| Rate for Payer: PHCS Commercial |
$6,599.70
|
| Rate for Payer: United Healthcare All Payer |
$6,049.73
|
|
|
TRI LM/RL TIB AUG SZ 5 5MM
|
Facility
|
OP
|
$6,874.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,062.41 |
| Max. Negotiated Rate |
$6,599.70 |
| Rate for Payer: Aetna Commercial |
$5,293.51
|
| Rate for Payer: Anthem Medicaid |
$2,364.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,362.26
|
| Rate for Payer: Cash Price |
$3,437.35
|
| Rate for Payer: Cigna Commercial |
$5,705.99
|
| Rate for Payer: First Health Commercial |
$6,530.96
|
| Rate for Payer: Humana Commercial |
$5,843.49
|
| Rate for Payer: Humana KY Medicaid |
$2,364.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,388.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,637.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,073.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,062.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,411.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,049.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,156.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,499.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,980.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,743.54
|
| Rate for Payer: PHCS Commercial |
$6,599.70
|
| Rate for Payer: United Healthcare All Payer |
$6,049.73
|
|
|
TRI LM/RL TIB AUG SZ 6 10MM
|
Facility
|
OP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem Medicaid |
$2,623.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Humana KY Medicaid |
$2,623.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,650.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI LM/RL TIB AUG SZ 6 10MM
|
Facility
|
IP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI LM/RL TIB AUG SZ 6 5MM
|
Facility
|
OP
|
$6,874.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,062.41 |
| Max. Negotiated Rate |
$6,599.70 |
| Rate for Payer: Aetna Commercial |
$5,293.51
|
| Rate for Payer: Anthem Medicaid |
$2,364.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,362.26
|
| Rate for Payer: Cash Price |
$3,437.35
|
| Rate for Payer: Cigna Commercial |
$5,705.99
|
| Rate for Payer: First Health Commercial |
$6,530.96
|
| Rate for Payer: Humana Commercial |
$5,843.49
|
| Rate for Payer: Humana KY Medicaid |
$2,364.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,388.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,637.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,073.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,062.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,411.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,049.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,156.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,499.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,980.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,743.54
|
| Rate for Payer: PHCS Commercial |
$6,599.70
|
| Rate for Payer: United Healthcare All Payer |
$6,049.73
|
|
|
TRI LM/RL TIB AUG SZ 6 5MM
|
Facility
|
IP
|
$6,874.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,062.41 |
| Max. Negotiated Rate |
$6,599.70 |
| Rate for Payer: Aetna Commercial |
$5,293.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,362.26
|
| Rate for Payer: Cash Price |
$3,437.35
|
| Rate for Payer: Cigna Commercial |
$5,705.99
|
| Rate for Payer: First Health Commercial |
$6,530.96
|
| Rate for Payer: Humana Commercial |
$5,843.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,637.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,073.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,062.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,049.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,156.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,499.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,980.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,743.54
|
| Rate for Payer: PHCS Commercial |
$6,599.70
|
| Rate for Payer: United Healthcare All Payer |
$6,049.73
|
|
|
TRI LM/RL TIB AUG SZ 7 10MM
|
Facility
|
OP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem Medicaid |
$2,623.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Humana KY Medicaid |
$2,623.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,650.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI LM/RL TIB AUG SZ 7 10MM
|
Facility
|
IP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI LM/RL TIB AUG SZ 7 5MM
|
Facility
|
OP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem Medicaid |
$2,623.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Humana KY Medicaid |
$2,623.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,650.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI LM/RL TIB AUG SZ 7 5MM
|
Facility
|
IP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI LM/RL TIB AUG SZ 8 10MM
|
Facility
|
OP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem Medicaid |
$2,623.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Humana KY Medicaid |
$2,623.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,650.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI LM/RL TIB AUG SZ 8 10MM
|
Facility
|
IP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI LM/RL TIB AUG SZ 8 5MM
|
Facility
|
IP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI LM/RL TIB AUG SZ 8 5MM
|
Facility
|
OP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem Medicaid |
$2,623.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Humana KY Medicaid |
$2,623.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,650.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRILOCK FEM STEM SZ 0 STD 95MM
|
Facility
|
OP
|
$23,497.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,049.18 |
| Max. Negotiated Rate |
$22,557.36 |
| Rate for Payer: Aetna Commercial |
$18,092.88
|
| Rate for Payer: Anthem Medicaid |
$8,080.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,327.85
|
| Rate for Payer: Cash Price |
$11,748.62
|
| Rate for Payer: Cigna Commercial |
$19,502.72
|
| Rate for Payer: First Health Commercial |
$22,322.39
|
| Rate for Payer: Humana Commercial |
$19,972.66
|
| Rate for Payer: Humana KY Medicaid |
$8,080.70
|
| Rate for Payer: Kentucky WC Medicaid |
$8,162.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,267.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,340.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,049.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,242.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,677.58
|
| Rate for Payer: Ohio Health Group HMO |
$17,622.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,797.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,442.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,213.10
|
| Rate for Payer: PHCS Commercial |
$22,557.36
|
| Rate for Payer: United Healthcare All Payer |
$20,677.58
|
|
|
TRILOCK FEM STEM SZ 0 STD 95MM
|
Facility
|
IP
|
$23,497.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,049.18 |
| Max. Negotiated Rate |
$22,557.36 |
| Rate for Payer: Aetna Commercial |
$18,092.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,327.85
|
| Rate for Payer: Cash Price |
$11,748.62
|
| Rate for Payer: Cigna Commercial |
$19,502.72
|
| Rate for Payer: First Health Commercial |
$22,322.39
|
| Rate for Payer: Humana Commercial |
$19,972.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,267.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,340.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,049.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,677.58
|
| Rate for Payer: Ohio Health Group HMO |
$17,622.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,797.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,442.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,213.10
|
| Rate for Payer: PHCS Commercial |
$22,557.36
|
| Rate for Payer: United Healthcare All Payer |
$20,677.58
|
|
|
TRILOCK FEM STEM SZ 1 STD 97MM
|
Facility
|
IP
|
$23,497.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,049.18 |
| Max. Negotiated Rate |
$22,557.36 |
| Rate for Payer: Aetna Commercial |
$18,092.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,327.85
|
| Rate for Payer: Cash Price |
$11,748.62
|
| Rate for Payer: Cigna Commercial |
$19,502.72
|
| Rate for Payer: First Health Commercial |
$22,322.39
|
| Rate for Payer: Humana Commercial |
$19,972.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,267.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,340.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,049.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,677.58
|
| Rate for Payer: Ohio Health Group HMO |
$17,622.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,797.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,442.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,213.10
|
| Rate for Payer: PHCS Commercial |
$22,557.36
|
| Rate for Payer: United Healthcare All Payer |
$20,677.58
|
|
|
TRILOCK FEM STEM SZ 1 STD 97MM
|
Facility
|
OP
|
$23,497.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,049.18 |
| Max. Negotiated Rate |
$22,557.36 |
| Rate for Payer: Aetna Commercial |
$18,092.88
|
| Rate for Payer: Anthem Medicaid |
$8,080.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,327.85
|
| Rate for Payer: Cash Price |
$11,748.62
|
| Rate for Payer: Cigna Commercial |
$19,502.72
|
| Rate for Payer: First Health Commercial |
$22,322.39
|
| Rate for Payer: Humana Commercial |
$19,972.66
|
| Rate for Payer: Humana KY Medicaid |
$8,080.70
|
| Rate for Payer: Kentucky WC Medicaid |
$8,162.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,267.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,340.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,049.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,242.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,677.58
|
| Rate for Payer: Ohio Health Group HMO |
$17,622.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,797.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,442.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,213.10
|
| Rate for Payer: PHCS Commercial |
$22,557.36
|
| Rate for Payer: United Healthcare All Payer |
$20,677.58
|
|
|
TRIMMING OF NAILS
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
76100093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.42
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.41
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
TRIMMING OF NAILS
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
76100093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem Medicaid |
$65.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Humana KY Medicaid |
$65.00
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$65.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.41
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
TRIMMING OF NAILS
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
76100093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Ambetter Exchange |
$7.01
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.41
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$7.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.80
|
| Rate for Payer: Molina Healthcare Passport |
$9.61
|
| Rate for Payer: Multiplan PHCS |
$113.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.11
|
| Rate for Payer: UHCCP Medicaid |
$66.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.01
|
|
|
TRIMMING OF NAILS(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
761P0093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Ambetter Exchange |
$7.01
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.41
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$7.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.01
|
| 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 |
$9.11
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.01
|
|
