|
INSRT PULSE GEN W/MULT LEADS
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 33231
|
| Hospital Charge Code |
76101262
|
|
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
|
|
|
INSRT PULSE GEN W/MULT LEADS
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
HCPCS 33231
|
| Hospital Charge Code |
76101262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.65 |
| Max. Negotiated Rate |
$580.80 |
| Rate for Payer: Aetna Commercial |
$465.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$471.90
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$502.15
|
| Rate for Payer: First Health Commercial |
$574.75
|
| Rate for Payer: Humana Commercial |
$514.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$496.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$446.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$532.40
|
| Rate for Payer: Ohio Health Group HMO |
$453.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$187.55
|
| Rate for Payer: PHCS Commercial |
$580.80
|
| Rate for Payer: United Healthcare All Payer |
$532.40
|
|
|
INSRT PULSE GEN W/MULT LEADS
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 33231
|
| Hospital Charge Code |
76101262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.65 |
| Max. Negotiated Rate |
$39,829.45 |
| Rate for Payer: Aetna Commercial |
$465.85
|
| Rate for Payer: Anthem Medicaid |
$208.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28,449.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$471.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39,829.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$38,406.97
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$502.15
|
| Rate for Payer: First Health Commercial |
$574.75
|
| Rate for Payer: Humana Commercial |
$514.25
|
| Rate for Payer: Humana KY Medicaid |
$208.06
|
| Rate for Payer: Humana Medicare Advantage |
$28,449.61
|
| Rate for Payer: Kentucky WC Medicaid |
$210.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$496.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$446.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34,139.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$212.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$532.40
|
| Rate for Payer: Ohio Health Group HMO |
$453.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$187.55
|
| Rate for Payer: PHCS Commercial |
$580.80
|
| Rate for Payer: United Healthcare All Payer |
$532.40
|
|
|
INSRT/REDO PN/GASTR STIMUL
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 64590
|
| Hospital Charge Code |
76102339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.85 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$282.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.85
|
| Rate for Payer: Anthem Medicaid |
$126.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$279.61
|
| Rate for Payer: Healthspan PPO |
$374.76
|
| Rate for Payer: Humana Medicaid |
$126.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$213.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.35
|
| Rate for Payer: Molina Healthcare Passport |
$126.81
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$85.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.08
|
|
|
INSRT/REDO PN/GASTR STIMUL
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 64590
|
| Hospital Charge Code |
76102339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$26,483.74 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,916.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26,483.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$25,537.90
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$18,916.96
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,700.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
INSRT/REDO PN/GASTR STIMUL
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 64590
|
| Hospital Charge Code |
76102339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
INSRT/REDO PN/GASTR STIMUL(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 64590
|
| Hospital Charge Code |
761P2339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.85 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$282.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.85
|
| Rate for Payer: Anthem Medicaid |
$126.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$279.61
|
| Rate for Payer: Healthspan PPO |
$374.76
|
| Rate for Payer: Humana Medicaid |
$126.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$213.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.35
|
| Rate for Payer: Molina Healthcare Passport |
$126.81
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$85.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.08
|
|
|
INSRT W/JRNY CONST LK 1-2 11MM
|
Facility
|
IP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 1-2 11MM
|
Facility
|
OP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem Medicaid |
$4,679.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Humana KY Medicaid |
$4,679.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,773.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 1-2 13MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INSRT W/JRNY CONST LK 1-2 13MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INSRT W/JRNY CONST LK 1-2 15MM
|
Facility
|
IP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 1-2 15MM
|
Facility
|
OP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem Medicaid |
$4,679.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Humana KY Medicaid |
$4,679.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,773.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 3-4 11MM
|
Facility
|
OP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem Medicaid |
$4,679.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Humana KY Medicaid |
$4,679.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,773.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 3-4 11MM
|
Facility
|
IP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 3-4 13MM
|
Facility
|
OP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem Medicaid |
$4,679.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Humana KY Medicaid |
$4,679.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,773.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 3-4 13MM
|
Facility
|
IP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 3-4 15MM
|
Facility
|
IP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 3-4 15MM
|
Facility
|
OP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem Medicaid |
$4,679.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Humana KY Medicaid |
$4,679.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,773.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 5-6 11MM
|
Facility
|
IP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 5-6 11MM
|
Facility
|
OP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem Medicaid |
$4,679.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Humana KY Medicaid |
$4,679.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,773.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 5-6 13MM
|
Facility
|
OP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem Medicaid |
$4,679.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Humana KY Medicaid |
$4,679.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,773.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 5-6 13MM
|
Facility
|
IP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 5-6 15MM
|
Facility
|
OP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem Medicaid |
$4,679.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Humana KY Medicaid |
$4,679.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,773.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
|
INSRT W/JRNY CONST LK 5-6 15MM
|
Facility
|
IP
|
$13,608.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.11 |
| Max. Negotiated Rate |
$13,064.17 |
| Rate for Payer: Aetna Commercial |
$10,478.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,614.64
|
| Rate for Payer: Cash Price |
$6,804.26
|
| Rate for Payer: Cigna Commercial |
$11,295.06
|
| Rate for Payer: First Health Commercial |
$12,928.08
|
| Rate for Payer: Humana Commercial |
$11,567.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,158.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,043.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,082.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,975.49
|
| Rate for Payer: Ohio Health Group HMO |
$10,206.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,218.64
|
| Rate for Payer: PHCS Commercial |
$13,064.17
|
| Rate for Payer: United Healthcare All Payer |
$11,975.49
|
|
