|
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 |
$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 W/JRNY CONST LK 1-2 11MM
|
Facility
|
IP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 1-2 11MM
|
Facility
|
OP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem Medicaid |
$4,768.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Humana KY Medicaid |
$4,768.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,816.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,863.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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
|
OP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem Medicaid |
$4,768.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Humana KY Medicaid |
$4,768.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,816.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,863.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 1-2 15MM
|
Facility
|
IP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 3-4 11MM
|
Facility
|
IP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 3-4 11MM
|
Facility
|
OP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem Medicaid |
$4,768.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Humana KY Medicaid |
$4,768.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,816.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,863.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 3-4 13MM
|
Facility
|
OP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem Medicaid |
$4,768.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Humana KY Medicaid |
$4,768.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,816.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,863.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 3-4 13MM
|
Facility
|
IP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 3-4 15MM
|
Facility
|
OP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem Medicaid |
$4,768.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Humana KY Medicaid |
$4,768.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,816.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,863.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 3-4 15MM
|
Facility
|
IP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 5-6 11MM
|
Facility
|
IP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 5-6 11MM
|
Facility
|
OP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem Medicaid |
$4,768.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Humana KY Medicaid |
$4,768.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,816.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,863.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 5-6 13MM
|
Facility
|
IP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 5-6 13MM
|
Facility
|
OP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem Medicaid |
$4,768.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Humana KY Medicaid |
$4,768.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,816.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,863.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 5-6 15MM
|
Facility
|
IP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 5-6 15MM
|
Facility
|
OP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem Medicaid |
$4,768.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Humana KY Medicaid |
$4,768.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,816.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,863.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 7-8 11MM
|
Facility
|
OP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem Medicaid |
$4,768.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Humana KY Medicaid |
$4,768.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,816.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,863.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 7-8 11MM
|
Facility
|
IP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 7-8 13MM
|
Facility
|
OP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem Medicaid |
$4,768.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Humana KY Medicaid |
$4,768.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,816.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,863.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 7-8 13MM
|
Facility
|
IP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 7-8 15MM
|
Facility
|
IP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
|
INSRT W/JRNY CONST LK 7-8 15MM
|
Facility
|
OP
|
$13,865.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,159.50 |
| Max. Negotiated Rate |
$13,310.40 |
| Rate for Payer: Aetna Commercial |
$10,676.05
|
| Rate for Payer: Anthem Medicaid |
$4,768.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,814.70
|
| Rate for Payer: Cash Price |
$6,932.50
|
| Rate for Payer: Cigna Commercial |
$11,507.95
|
| Rate for Payer: First Health Commercial |
$13,171.75
|
| Rate for Payer: Humana Commercial |
$11,785.25
|
| Rate for Payer: Humana KY Medicaid |
$4,768.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,816.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,369.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,232.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,159.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,863.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,201.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,566.85
|
| Rate for Payer: PHCS Commercial |
$13,310.40
|
| Rate for Payer: United Healthcare All Payer |
$12,201.20
|
|
