|
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
|
|
|
INSERT JRNY REV STD 7-8 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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 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 R 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 7-8 R 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 MDM X3 22.2*36 SZ 36C
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
INSERT MDM X3 22.2*36 SZ 36C
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
INSERT MDM X3 22.2*38 SZ 38D
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
INSERT MDM X3 22.2*38 SZ 38D
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
INSERT MESH/PELVIC FLR ADDON
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 57267
|
| Hospital Charge Code |
76102184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.63 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$418.79
|
| Rate for Payer: Anthem Medicaid |
$211.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$408.41
|
| Rate for Payer: Healthspan PPO |
$405.50
|
| Rate for Payer: Humana Medicaid |
$211.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$338.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.86
|
| Rate for Payer: Molina Healthcare Passport |
$211.63
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.75
|
|
|
INSERT MESH/PELVIC FLR ADDON
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 57267
|
| Hospital Charge Code |
76102184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
INSERT MESH/PELVIC FLR ADDON
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 57267
|
| Hospital Charge Code |
76102184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
INSERT MESH/PELVIC FLR ADDO(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 57267
|
| Hospital Charge Code |
761P2184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.63 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$418.79
|
| Rate for Payer: Anthem Medicaid |
$211.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$408.41
|
| Rate for Payer: Healthspan PPO |
$405.50
|
| Rate for Payer: Humana Medicaid |
$211.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$338.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.86
|
| Rate for Payer: Molina Healthcare Passport |
$211.63
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.75
|
|
