|
INSRT JRNY ARTBCS STD 1-2 15 L
|
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
|
|
|
INSRT JRNY ARTBCS STD 1-2 15 L
|
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
|
|
|
INSRT JRNY ARTBCS STD 1-2 15 R
|
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
|
|
|
INSRT JRNY ARTBCS STD 1-2 15 R
|
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
|
|
|
INSRT JRNY ARTBCS STD 1-2 18 L
|
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
|
|
|
INSRT JRNY ARTBCS STD 1-2 18 L
|
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
|
|
|
INSRT JRNY ARTBCS STD 1-2 18 R
|
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
|
|
|
INSRT JRNY ARTBCS STD 1-2 18 R
|
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
|
|
|
INSRT JRNY ART BCS STD 1-2 9 L
|
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
|
|
|
INSRT JRNY ART BCS STD 1-2 9 L
|
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
|
|
|
INSRT JRNY ART BCS STD 1-2 9 R
|
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
|
|
|
INSRT JRNY ART BCS STD 1-2 9 R
|
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
|
|
|
INSRT JRNY ARTBCS STD 3-4 10 R
|
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
|
|
|
INSRT JRNY ARTBCS STD 3-4 10 R
|
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
|
|
|
INSRT JRNY ARTBCS STD 3-4 11 R
|
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
|
|
|
INSRT JRNY ARTBCS STD 3-4 11 R
|
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
|
|
|
INSRT JRNY ARTBCS STD 3-4 13 R
|
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
|
|
|
INSRT JRNY ARTBCS STD 3-4 13 R
|
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
|
|
|
INSRT JRNY ART BCS STD 3-4 9 R
|
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
|
|
|
INSRT JRNY ART BCS STD 3-4 9 R
|
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
|
|
|
INSRT PULSE GEN W/DUAL LEAD(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33230
|
| Hospital Charge Code |
761P1261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.31 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Anthem Medicaid |
$306.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$710.27
|
| Rate for Payer: Healthspan PPO |
$477.44
|
| Rate for Payer: Humana Medicaid |
$306.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$511.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$312.44
|
| Rate for Payer: Molina Healthcare Passport |
$306.31
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$309.37
|
|
|
INSRT PULSE GEN W/DUAL LEADS
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33230
|
| Hospital Charge Code |
76101261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
INSRT PULSE GEN W/DUAL LEADS
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33230
|
| Hospital Charge Code |
76101261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$28,536.86 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,383.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28,536.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$27,517.68
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$20,383.47
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,460.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
INSRT PULSE GEN W/DUAL LEADS
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33230
|
| Hospital Charge Code |
76101261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.31 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Anthem Medicaid |
$306.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$710.27
|
| Rate for Payer: Healthspan PPO |
$477.44
|
| Rate for Payer: Humana Medicaid |
$306.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$511.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$312.44
|
| Rate for Payer: Molina Healthcare Passport |
$306.31
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$309.37
|
|
|
INSRT PULSE GEN W/MULT LEAD(P
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 33231
|
| Hospital Charge Code |
761P1262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.75 |
| Max. Negotiated Rate |
$737.41 |
| Rate for Payer: Anthem Medicaid |
$318.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$605.00
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$737.41
|
| Rate for Payer: Healthspan PPO |
$495.75
|
| Rate for Payer: Humana Medicaid |
$318.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$531.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$324.37
|
| Rate for Payer: Molina Healthcare Passport |
$318.01
|
| Rate for Payer: Multiplan PHCS |
$363.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$423.50
|
| Rate for Payer: UHCCP Medicaid |
$211.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.19
|
|
