|
TRI RM/LL TIB AUG SZ 3 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 RM/LL TIB AUG SZ 4 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 RM/LL TIB AUG SZ 4 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 RM/LL 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 RM/LL TIB AUG SZ 4 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 RM/LL TIB AUG SZ 5 10MM
|
Facility
|
IP
|
$7,737.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,321.31 |
| Max. Negotiated Rate |
$7,428.19 |
| Rate for Payer: Aetna Commercial |
$5,958.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,035.41
|
| Rate for Payer: Cash Price |
$3,868.85
|
| Rate for Payer: Cigna Commercial |
$6,422.29
|
| Rate for Payer: First Health Commercial |
$7,350.81
|
| Rate for Payer: Humana Commercial |
$6,577.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,344.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,710.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,321.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,809.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,803.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,190.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,731.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,339.01
|
| Rate for Payer: PHCS Commercial |
$7,428.19
|
| Rate for Payer: United Healthcare All Payer |
$6,809.18
|
|
|
TRI RM/LL TIB AUG SZ 5 10MM
|
Facility
|
OP
|
$7,737.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,321.31 |
| Max. Negotiated Rate |
$7,428.19 |
| Rate for Payer: Aetna Commercial |
$5,958.03
|
| Rate for Payer: Anthem Medicaid |
$2,661.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,035.41
|
| Rate for Payer: Cash Price |
$3,868.85
|
| Rate for Payer: Cigna Commercial |
$6,422.29
|
| Rate for Payer: First Health Commercial |
$7,350.81
|
| Rate for Payer: Humana Commercial |
$6,577.05
|
| Rate for Payer: Humana KY Medicaid |
$2,661.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,688.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,344.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,710.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,321.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,714.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,809.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,803.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,190.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,731.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,339.01
|
| Rate for Payer: PHCS Commercial |
$7,428.19
|
| Rate for Payer: United Healthcare All Payer |
$6,809.18
|
|
|
TRI RM/LL TIB AUG SZ 5 5MM
|
Facility
|
OP
|
$7,248.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,174.58 |
| Max. Negotiated Rate |
$6,958.66 |
| Rate for Payer: Aetna Commercial |
$5,581.42
|
| Rate for Payer: Anthem Medicaid |
$2,492.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,653.91
|
| Rate for Payer: Cash Price |
$3,624.30
|
| Rate for Payer: Cigna Commercial |
$6,016.34
|
| Rate for Payer: First Health Commercial |
$6,886.17
|
| Rate for Payer: Humana Commercial |
$6,161.31
|
| Rate for Payer: Humana KY Medicaid |
$2,492.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,518.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,943.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,349.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,174.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,542.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,378.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,436.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,798.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,306.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,001.53
|
| Rate for Payer: PHCS Commercial |
$6,958.66
|
| Rate for Payer: United Healthcare All Payer |
$6,378.77
|
|
|
TRI RM/LL TIB AUG SZ 5 5MM
|
Facility
|
IP
|
$7,248.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,174.58 |
| Max. Negotiated Rate |
$6,958.66 |
| Rate for Payer: Aetna Commercial |
$5,581.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,653.91
|
| Rate for Payer: Cash Price |
$3,624.30
|
| Rate for Payer: Cigna Commercial |
$6,016.34
|
| Rate for Payer: First Health Commercial |
$6,886.17
|
| Rate for Payer: Humana Commercial |
$6,161.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,943.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,349.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,174.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,378.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,436.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,798.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,306.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,001.53
|
| Rate for Payer: PHCS Commercial |
$6,958.66
|
| Rate for Payer: United Healthcare All Payer |
$6,378.77
|
|
|
TRI RM/LL TIB AUG SZ 6 10MM
|
Facility
|
OP
|
$7,005.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.57 |
| Max. Negotiated Rate |
$6,725.04 |
| Rate for Payer: Aetna Commercial |
$5,394.04
|
| Rate for Payer: Anthem Medicaid |
$2,409.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,464.10
|
| Rate for Payer: Cash Price |
$3,502.63
|
| Rate for Payer: Cigna Commercial |
$5,814.36
|
| Rate for Payer: First Health Commercial |
$6,654.99
|
| Rate for Payer: Humana Commercial |
$5,954.46
|
| Rate for Payer: Humana KY Medicaid |
$2,409.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,433.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,744.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,169.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,457.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,253.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,604.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,094.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,833.62
|
| Rate for Payer: PHCS Commercial |
$6,725.04
|
| Rate for Payer: United Healthcare All Payer |
$6,164.62
|
|
|
TRI RM/LL TIB AUG SZ 6 10MM
|
Facility
|
IP
|
$7,005.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.57 |
| Max. Negotiated Rate |
$6,725.04 |
| Rate for Payer: Aetna Commercial |
$5,394.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,464.10
|
| Rate for Payer: Cash Price |
$3,502.63
|
| Rate for Payer: Cigna Commercial |
$5,814.36
|
| Rate for Payer: First Health Commercial |
$6,654.99
|
| Rate for Payer: Humana Commercial |
$5,954.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,744.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,169.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,253.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,604.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,094.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,833.62
|
| Rate for Payer: PHCS Commercial |
$6,725.04
|
| Rate for Payer: United Healthcare All Payer |
$6,164.62
|
|
|
TRI RM/LL TIB AUG SZ 6 5MM
|
Facility
|
IP
|
$8,005.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.57 |
| Max. Negotiated Rate |
$7,685.03 |
| Rate for Payer: Aetna Commercial |
$6,164.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,244.09
|
| Rate for Payer: Cash Price |
$4,002.62
|
| Rate for Payer: Cigna Commercial |
$6,644.35
|
| Rate for Payer: First Health Commercial |
$7,604.98
|
| Rate for Payer: Humana Commercial |
$6,804.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,564.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,907.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,044.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,003.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,404.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,964.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,523.62
|
| Rate for Payer: PHCS Commercial |
$7,685.03
|
| Rate for Payer: United Healthcare All Payer |
$7,044.61
|
|
|
TRI RM/LL TIB AUG SZ 6 5MM
|
Facility
|
OP
|
$8,005.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.57 |
| Max. Negotiated Rate |
$7,685.03 |
| Rate for Payer: Aetna Commercial |
$6,164.03
|
| Rate for Payer: Anthem Medicaid |
$2,753.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,244.09
|
| Rate for Payer: Cash Price |
$4,002.62
|
| Rate for Payer: Cigna Commercial |
$6,644.35
|
| Rate for Payer: First Health Commercial |
$7,604.98
|
| Rate for Payer: Humana Commercial |
$6,804.45
|
| Rate for Payer: Humana KY Medicaid |
$2,753.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,781.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,564.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,907.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,808.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,044.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,003.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,404.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,964.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,523.62
|
| Rate for Payer: PHCS Commercial |
$7,685.03
|
| Rate for Payer: United Healthcare All Payer |
$7,044.61
|
|
|
TRI RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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
|
|
|
TRISENOX 1MG[10MG/10ML AMP
|
Facility
|
IP
|
$3,064.21
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
25002558
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$919.26 |
| Max. Negotiated Rate |
$2,941.64 |
| Rate for Payer: Aetna Commercial |
$2,359.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,390.08
|
| Rate for Payer: Cash Price |
$1,532.11
|
| Rate for Payer: Cigna Commercial |
$2,543.29
|
| Rate for Payer: First Health Commercial |
$2,911.00
|
| Rate for Payer: Humana Commercial |
$2,604.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,512.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,261.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$919.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,696.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,298.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,451.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,665.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,114.30
|
| Rate for Payer: PHCS Commercial |
$2,941.64
|
| Rate for Payer: United Healthcare All Payer |
$2,696.50
|
|
|
TRISENOX 1MG[10MG/10ML AMP
|
Facility
|
OP
|
$3,064.21
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
25002558
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$2,941.64 |
| Rate for Payer: Aetna Commercial |
$2,359.44
|
| Rate for Payer: Anthem Medicaid |
$1,053.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,390.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.91
|
| Rate for Payer: Cash Price |
$1,532.11
|
| Rate for Payer: Cash Price |
$1,532.11
|
| Rate for Payer: Cigna Commercial |
$2,543.29
|
| Rate for Payer: First Health Commercial |
$2,911.00
|
| Rate for Payer: Humana Commercial |
$2,604.58
|
| Rate for Payer: Humana KY Medicaid |
$1,053.78
|
| Rate for Payer: Humana Medicare Advantage |
$5.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,064.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,512.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,261.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,074.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,696.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,298.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,451.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,665.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,114.30
|
| Rate for Payer: PHCS Commercial |
$2,941.64
|
| Rate for Payer: United Healthcare All Payer |
$2,696.50
|
|
|
TRITANIUM CENT FEM CONE AUG
|
Facility
|
IP
|
$27,236.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,170.81 |
| Max. Negotiated Rate |
$26,146.60 |
| Rate for Payer: Aetna Commercial |
$20,971.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,244.11
|
| Rate for Payer: Cash Price |
$13,618.02
|
| Rate for Payer: Cigna Commercial |
$22,605.91
|
| Rate for Payer: First Health Commercial |
$25,874.24
|
| Rate for Payer: Humana Commercial |
$23,150.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,100.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,170.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,967.72
|
| Rate for Payer: Ohio Health Group HMO |
$20,427.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,788.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,695.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,792.87
|
| Rate for Payer: PHCS Commercial |
$26,146.60
|
| Rate for Payer: United Healthcare All Payer |
$23,967.72
|
|
|
TRITANIUM CENT FEM CONE AUG
|
Facility
|
OP
|
$27,236.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,170.81 |
| Max. Negotiated Rate |
$26,146.60 |
| Rate for Payer: Aetna Commercial |
$20,971.75
|
| Rate for Payer: Anthem Medicaid |
$9,366.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,244.11
|
| Rate for Payer: Cash Price |
$13,618.02
|
| Rate for Payer: Cigna Commercial |
$22,605.91
|
| Rate for Payer: First Health Commercial |
$25,874.24
|
| Rate for Payer: Humana Commercial |
$23,150.63
|
| Rate for Payer: Humana KY Medicaid |
$9,366.47
|
| Rate for Payer: Kentucky WC Medicaid |
$9,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,100.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,170.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,554.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,967.72
|
| Rate for Payer: Ohio Health Group HMO |
$20,427.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,788.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,695.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,792.87
|
| Rate for Payer: PHCS Commercial |
$26,146.60
|
| Rate for Payer: United Healthcare All Payer |
$23,967.72
|
|
