JOURNEY FEM OX NP BCS LT SZ 2
|
Facility
|
OP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem Medicaid |
$7,290.61
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Humana KY Medicaid |
$7,290.61
|
Rate for Payer: Kentucky WC Medicaid |
$7,364.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Molina Healthcare Medicaid |
$7,436.89
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS LT SZ 3
|
Facility
|
OP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem Medicaid |
$7,290.61
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Humana KY Medicaid |
$7,290.61
|
Rate for Payer: Kentucky WC Medicaid |
$7,364.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Molina Healthcare Medicaid |
$7,436.89
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS LT SZ 3
|
Facility
|
IP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS LT SZ 4
|
Facility
|
IP
|
$15,282.24
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,986.69 |
Max. Negotiated Rate |
$14,670.95 |
Rate for Payer: Aetna Commercial |
$11,767.32
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.15
|
Rate for Payer: Cash Price |
$7,641.12
|
Rate for Payer: Cigna Commercial |
$12,684.26
|
Rate for Payer: First Health Commercial |
$14,518.13
|
Rate for Payer: Humana Commercial |
$12,989.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$12,531.44
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.29
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.67
|
Rate for Payer: Ohio Health Choice Commercial |
$13,448.37
|
Rate for Payer: Ohio Health Group HMO |
$11,461.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$3,056.45
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.69
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.49
|
Rate for Payer: PHCS Commercial |
$14,670.95
|
Rate for Payer: United Healthcare All Payer |
$13,448.37
|
|
JOURNEY FEM OX NP BCS LT SZ 4
|
Facility
|
OP
|
$15,282.24
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,986.69 |
Max. Negotiated Rate |
$14,670.95 |
Rate for Payer: Aetna Commercial |
$11,767.32
|
Rate for Payer: Anthem Medicaid |
$5,255.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.15
|
Rate for Payer: Cash Price |
$7,641.12
|
Rate for Payer: Cigna Commercial |
$12,684.26
|
Rate for Payer: First Health Commercial |
$14,518.13
|
Rate for Payer: Humana Commercial |
$12,989.90
|
Rate for Payer: Humana KY Medicaid |
$5,255.56
|
Rate for Payer: Kentucky WC Medicaid |
$5,309.05
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$12,531.44
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.29
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.67
|
Rate for Payer: Molina Healthcare Medicaid |
$5,361.01
|
Rate for Payer: Ohio Health Choice Commercial |
$13,448.37
|
Rate for Payer: Ohio Health Group HMO |
$11,461.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$3,056.45
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.69
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.49
|
Rate for Payer: PHCS Commercial |
$14,670.95
|
Rate for Payer: United Healthcare All Payer |
$13,448.37
|
|
JOURNEY FEM OX NP BCS LT SZ 5
|
Facility
|
OP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem Medicaid |
$7,290.61
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Humana KY Medicaid |
$7,290.61
|
Rate for Payer: Kentucky WC Medicaid |
$7,364.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Molina Healthcare Medicaid |
$7,436.89
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS LT SZ 5
|
Facility
|
IP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS LT SZ 6
|
Facility
|
OP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem Medicaid |
$7,290.61
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Humana KY Medicaid |
$7,290.61
|
Rate for Payer: Kentucky WC Medicaid |
$7,364.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Molina Healthcare Medicaid |
$7,436.89
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS LT SZ 6
|
Facility
|
IP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS LT SZ 7
|
Facility
|
OP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem Medicaid |
$7,290.61
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Humana KY Medicaid |
$7,290.61
|
Rate for Payer: Kentucky WC Medicaid |
$7,364.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Molina Healthcare Medicaid |
$7,436.89
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS LT SZ 7
|
Facility
|
IP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS LT SZ 8
|
Facility
|
IP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS LT SZ 8
|
Facility
|
OP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem Medicaid |
$7,290.61
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Humana KY Medicaid |
$7,290.61
|
Rate for Payer: Kentucky WC Medicaid |
$7,364.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Molina Healthcare Medicaid |
$7,436.89
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS LT SZ 9
|
Facility
|
IP
|
$14,104.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,833.52 |
Max. Negotiated Rate |
$13,539.84 |
Rate for Payer: Aetna Commercial |
$10,860.08
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,001.12
|
Rate for Payer: Cash Price |
$7,052.00
|
Rate for Payer: Cigna Commercial |
$11,706.32
|
Rate for Payer: First Health Commercial |
$13,398.80
|
Rate for Payer: Humana Commercial |
$11,988.40
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,565.28
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.75
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.20
|
Rate for Payer: Ohio Health Choice Commercial |
$12,411.52
|
Rate for Payer: Ohio Health Group HMO |
$10,578.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,820.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,833.52
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,372.24
|
Rate for Payer: PHCS Commercial |
$13,539.84
|
Rate for Payer: United Healthcare All Payer |
$12,411.52
|
|
JOURNEY FEM OX NP BCS LT SZ 9
|
Facility
|
OP
|
$14,104.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,833.52 |
Max. Negotiated Rate |
$13,539.84 |
Rate for Payer: Aetna Commercial |
$10,860.08
|
Rate for Payer: Anthem Medicaid |
$4,850.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,001.12
|
Rate for Payer: Cash Price |
$7,052.00
|
Rate for Payer: Cigna Commercial |
$11,706.32
|
Rate for Payer: First Health Commercial |
$13,398.80
|
Rate for Payer: Humana Commercial |
$11,988.40
|
Rate for Payer: Humana KY Medicaid |
$4,850.37
|
Rate for Payer: Kentucky WC Medicaid |
$4,899.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,565.28
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.75
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.20
|
Rate for Payer: Molina Healthcare Medicaid |
$4,947.68
|
Rate for Payer: Ohio Health Choice Commercial |
$12,411.52
|
Rate for Payer: Ohio Health Group HMO |
$10,578.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,820.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,833.52
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,372.24
|
Rate for Payer: PHCS Commercial |
$13,539.84
|
Rate for Payer: United Healthcare All Payer |
$12,411.52
|
|
JOURNEY FEM OX NP BCS RT SZ 1
|
Facility
|
OP
|
$14,104.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,833.52 |
Max. Negotiated Rate |
$13,539.84 |
Rate for Payer: Aetna Commercial |
$10,860.08
|
Rate for Payer: Anthem Medicaid |
$4,850.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,001.12
|
Rate for Payer: Cash Price |
$7,052.00
|
Rate for Payer: Cigna Commercial |
$11,706.32
|
Rate for Payer: First Health Commercial |
$13,398.80
|
Rate for Payer: Humana Commercial |
$11,988.40
|
Rate for Payer: Humana KY Medicaid |
$4,850.37
|
Rate for Payer: Kentucky WC Medicaid |
$4,899.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,565.28
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.75
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.20
|
Rate for Payer: Molina Healthcare Medicaid |
$4,947.68
|
Rate for Payer: Ohio Health Choice Commercial |
$12,411.52
|
Rate for Payer: Ohio Health Group HMO |
$10,578.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,820.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,833.52
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,372.24
|
Rate for Payer: PHCS Commercial |
$13,539.84
|
Rate for Payer: United Healthcare All Payer |
$12,411.52
|
|
JOURNEY FEM OX NP BCS RT SZ 1
|
Facility
|
IP
|
$14,104.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,833.52 |
Max. Negotiated Rate |
$13,539.84 |
Rate for Payer: Aetna Commercial |
$10,860.08
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,001.12
|
Rate for Payer: Cash Price |
$7,052.00
|
Rate for Payer: Cigna Commercial |
$11,706.32
|
Rate for Payer: First Health Commercial |
$13,398.80
|
Rate for Payer: Humana Commercial |
$11,988.40
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,565.28
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.75
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.20
|
Rate for Payer: Ohio Health Choice Commercial |
$12,411.52
|
Rate for Payer: Ohio Health Group HMO |
$10,578.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,820.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,833.52
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,372.24
|
Rate for Payer: PHCS Commercial |
$13,539.84
|
Rate for Payer: United Healthcare All Payer |
$12,411.52
|
|
JOURNEY FEM OX NP BCS RT SZ 10
|
Facility
|
OP
|
$14,104.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,833.52 |
Max. Negotiated Rate |
$13,539.84 |
Rate for Payer: Aetna Commercial |
$10,860.08
|
Rate for Payer: Anthem Medicaid |
$4,850.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,001.12
|
Rate for Payer: Cash Price |
$7,052.00
|
Rate for Payer: Cigna Commercial |
$11,706.32
|
Rate for Payer: First Health Commercial |
$13,398.80
|
Rate for Payer: Humana Commercial |
$11,988.40
|
Rate for Payer: Humana KY Medicaid |
$4,850.37
|
Rate for Payer: Kentucky WC Medicaid |
$4,899.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,565.28
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.75
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.20
|
Rate for Payer: Molina Healthcare Medicaid |
$4,947.68
|
Rate for Payer: Ohio Health Choice Commercial |
$12,411.52
|
Rate for Payer: Ohio Health Group HMO |
$10,578.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,820.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,833.52
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,372.24
|
Rate for Payer: PHCS Commercial |
$13,539.84
|
Rate for Payer: United Healthcare All Payer |
$12,411.52
|
|
JOURNEY FEM OX NP BCS RT SZ 10
|
Facility
|
IP
|
$14,104.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,833.52 |
Max. Negotiated Rate |
$13,539.84 |
Rate for Payer: Aetna Commercial |
$10,860.08
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,001.12
|
Rate for Payer: Cash Price |
$7,052.00
|
Rate for Payer: Cigna Commercial |
$11,706.32
|
Rate for Payer: First Health Commercial |
$13,398.80
|
Rate for Payer: Humana Commercial |
$11,988.40
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,565.28
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.75
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.20
|
Rate for Payer: Ohio Health Choice Commercial |
$12,411.52
|
Rate for Payer: Ohio Health Group HMO |
$10,578.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,820.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,833.52
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,372.24
|
Rate for Payer: PHCS Commercial |
$13,539.84
|
Rate for Payer: United Healthcare All Payer |
$12,411.52
|
|
JOURNEY FEM OX NP BCS RT SZ 2
|
Facility
|
OP
|
$15,282.24
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,986.69 |
Max. Negotiated Rate |
$14,670.95 |
Rate for Payer: Aetna Commercial |
$11,767.32
|
Rate for Payer: Anthem Medicaid |
$5,255.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.15
|
Rate for Payer: Cash Price |
$7,641.12
|
Rate for Payer: Cigna Commercial |
$12,684.26
|
Rate for Payer: First Health Commercial |
$14,518.13
|
Rate for Payer: Humana Commercial |
$12,989.90
|
Rate for Payer: Humana KY Medicaid |
$5,255.56
|
Rate for Payer: Kentucky WC Medicaid |
$5,309.05
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$12,531.44
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.29
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.67
|
Rate for Payer: Molina Healthcare Medicaid |
$5,361.01
|
Rate for Payer: Ohio Health Choice Commercial |
$13,448.37
|
Rate for Payer: Ohio Health Group HMO |
$11,461.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$3,056.45
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.69
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.49
|
Rate for Payer: PHCS Commercial |
$14,670.95
|
Rate for Payer: United Healthcare All Payer |
$13,448.37
|
|
JOURNEY FEM OX NP BCS RT SZ 2
|
Facility
|
IP
|
$15,282.24
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,986.69 |
Max. Negotiated Rate |
$14,670.95 |
Rate for Payer: Aetna Commercial |
$11,767.32
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.15
|
Rate for Payer: Cash Price |
$7,641.12
|
Rate for Payer: Cigna Commercial |
$12,684.26
|
Rate for Payer: First Health Commercial |
$14,518.13
|
Rate for Payer: Humana Commercial |
$12,989.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$12,531.44
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.29
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.67
|
Rate for Payer: Ohio Health Choice Commercial |
$13,448.37
|
Rate for Payer: Ohio Health Group HMO |
$11,461.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$3,056.45
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.69
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.49
|
Rate for Payer: PHCS Commercial |
$14,670.95
|
Rate for Payer: United Healthcare All Payer |
$13,448.37
|
|
JOURNEY FEM OX NP BCS RT SZ 3
|
Facility
|
OP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem Medicaid |
$7,290.61
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Humana KY Medicaid |
$7,290.61
|
Rate for Payer: Kentucky WC Medicaid |
$7,364.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Molina Healthcare Medicaid |
$7,436.89
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS RT SZ 3
|
Facility
|
IP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS RT SZ 4
|
Facility
|
OP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem Medicaid |
$7,290.61
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Humana KY Medicaid |
$7,290.61
|
Rate for Payer: Kentucky WC Medicaid |
$7,364.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Molina Healthcare Medicaid |
$7,436.89
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|
JOURNEY FEM OX NP BCS RT SZ 4
|
Facility
|
IP
|
$21,199.81
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,755.98 |
Max. Negotiated Rate |
$20,351.82 |
Rate for Payer: Aetna Commercial |
$16,323.85
|
Rate for Payer: Anthem POS/PPO/Traditional |
$16,535.85
|
Rate for Payer: Cash Price |
$10,599.91
|
Rate for Payer: Cigna Commercial |
$17,595.84
|
Rate for Payer: First Health Commercial |
$20,139.82
|
Rate for Payer: Humana Commercial |
$18,019.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$17,383.84
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,645.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,359.94
|
Rate for Payer: Ohio Health Choice Commercial |
$18,655.83
|
Rate for Payer: Ohio Health Group HMO |
$15,899.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,239.96
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,755.98
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,571.94
|
Rate for Payer: PHCS Commercial |
$20,351.82
|
Rate for Payer: United Healthcare All Payer |
$18,655.83
|
|