|
INSERT JRNY REV STD 5-6 L 13
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 L 13
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 L 15
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 L 15
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 L 18
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 L 18
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 L 9
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 L 9
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 R 10
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 R 10
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 R 11
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 R 11
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 R 13
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 R 13
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 R 15
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 R 15
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 R 18
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 R 18
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 7-8 L 10
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 7-8 L 10
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 7-8 L 11
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 7-8 L 11
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 7-8 L 13
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 7-8 L 13
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 7-8 L 15
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
