|
INSRT JRNY ARTBCS STD 1-2 18 R
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 18 R
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ART BCS STD 1-2 9 L
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ART BCS STD 1-2 9 L
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ART BCS STD 1-2 9 R
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ART BCS STD 1-2 9 R
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 3-4 10 R
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 3-4 10 R
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 3-4 11 R
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 3-4 11 R
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 3-4 13 R
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 3-4 13 R
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ART BCS STD 3-4 9 R
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ART BCS STD 3-4 9 R
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
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 |
$710.27 |
| Rate for Payer: Ambetter Exchange |
$349.17
|
| Rate for Payer: Anthem Medicaid |
$306.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$349.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$349.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$419.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$349.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.17
|
| 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 |
$453.92
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$309.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$349.17
|
|
|
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 |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| 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 |
$343.90 |
| Max. Negotiated Rate |
$29,035.76 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,739.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29,035.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$27,998.77
|
| 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 |
$20,739.83
|
| 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 |
$24,887.80
|
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| 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 |
$710.27 |
| Rate for Payer: Ambetter Exchange |
$349.17
|
| Rate for Payer: Anthem Medicaid |
$306.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$349.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$349.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$419.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$349.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.17
|
| 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 |
$453.92
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$309.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$349.17
|
|
|
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: Ambetter Exchange |
$373.34
|
| Rate for Payer: Anthem Medicaid |
$318.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$373.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$373.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.01
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$373.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.34
|
| 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 |
$485.34
|
| Rate for Payer: UHCCP Medicaid |
$211.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$373.34
|
|
|
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 |
$208.06 |
| Max. Negotiated Rate |
$41,473.96 |
| Rate for Payer: Aetna Commercial |
$465.85
|
| Rate for Payer: Anthem Medicaid |
$208.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29,624.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$471.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41,473.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$39,992.75
|
| 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 |
$29,624.26
|
| 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 |
$35,549.11
|
| 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 |
$484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$526.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$417.45
|
| Rate for Payer: PHCS Commercial |
$580.80
|
| Rate for Payer: United Healthcare All Payer |
$532.40
|
|
|
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: Ambetter Exchange |
$373.34
|
| Rate for Payer: Anthem Medicaid |
$318.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$373.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$373.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.01
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$373.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.34
|
| 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 |
$485.34
|
| Rate for Payer: UHCCP Medicaid |
$211.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$373.34
|
|
|
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 |
$181.50 |
| 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 |
$484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$526.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$417.45
|
| 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 |
$374.76 |
| Rate for Payer: Aetna Commercial |
$282.86
|
| Rate for Payer: Ambetter Exchange |
$278.86
|
| 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 Individual/Medicaid |
$278.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$278.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$334.63
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$278.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.86
|
| 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 |
$362.52
|
| Rate for Payer: UHCCP Medicaid |
$85.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$278.86
|
|
|
INSRT/REDO PN/GASTR STIMUL
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 64590
|
| Hospital Charge Code |
76102339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$27,739.87 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19,814.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27,739.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$26,749.16
|
| 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 |
$19,814.19
|
| 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 |
$23,777.03
|
| 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 |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| 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 |
$180.00 |
| 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 |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
