|
JOURNEY FEM OX NP BCS RT 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 RT 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 RT 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 RT 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 RT 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 RT 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 RT 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 RT 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 RT SZ 9
|
Facility
|
OP
|
$21,966.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.60 |
| Max. Negotiated Rate |
$21,087.48 |
| Rate for Payer: Aetna Commercial |
$16,913.92
|
| Rate for Payer: Anthem Medicaid |
$7,554.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,133.58
|
| Rate for Payer: Cash Price |
$10,983.07
|
| Rate for Payer: Cigna Commercial |
$18,231.89
|
| Rate for Payer: First Health Commercial |
$20,867.82
|
| Rate for Payer: Humana Commercial |
$18,671.21
|
| Rate for Payer: Humana KY Medicaid |
$7,554.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,631.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,012.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,211.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,589.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,705.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,330.19
|
| Rate for Payer: Ohio Health Group HMO |
$16,474.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,855.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,809.50
|
| Rate for Payer: PHCS Commercial |
$21,087.48
|
| Rate for Payer: United Healthcare All Payer |
$19,330.19
|
|
|
JOURNEY FEM OX NP BCS RT SZ 9
|
Facility
|
IP
|
$21,966.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.60 |
| Max. Negotiated Rate |
$21,087.48 |
| Rate for Payer: Aetna Commercial |
$16,913.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,133.58
|
| Rate for Payer: Cash Price |
$10,983.07
|
| Rate for Payer: Cigna Commercial |
$18,231.89
|
| Rate for Payer: First Health Commercial |
$20,867.82
|
| Rate for Payer: Humana Commercial |
$18,671.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,012.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,211.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,589.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,330.19
|
| Rate for Payer: Ohio Health Group HMO |
$16,474.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,855.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,809.50
|
| Rate for Payer: PHCS Commercial |
$21,087.48
|
| Rate for Payer: United Healthcare All Payer |
$19,330.19
|
|
|
JOURNEY II BCS FEM COCR SZ 1 L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 1 L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 1 R
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 1 R
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 2 L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 2 L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 2 R
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 2 R
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 3 L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 3 L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 3 R
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 3 R
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 4 L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 4 L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 5 L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
