|
JOURNEY II CR FEM OX NP SZ 5 L
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 5 L
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 5 R
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 5 R
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 6 L
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 6 L
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 6 R
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 6 R
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 7 L
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 7 L
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 7 R
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 7 R
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 8 L
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 8 L
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 8 R
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 8 R
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 9 L
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 9 L
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 9 R
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CR FEM OX NP SZ 9 R
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
JOURNEY II CSTD ARTSZ 1-2*10 L
|
Facility
|
IP
|
$13,845.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.95 |
| Max. Negotiated Rate |
$13,291.93 |
| Rate for Payer: Aetna Commercial |
$10,661.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,799.69
|
| Rate for Payer: Cash Price |
$6,922.88
|
| Rate for Payer: Cigna Commercial |
$11,491.98
|
| Rate for Payer: First Health Commercial |
$13,153.47
|
| Rate for Payer: Humana Commercial |
$11,768.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,353.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,218.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,153.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,184.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,384.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,292.19
|
| Rate for Payer: PHCS Commercial |
$13,291.93
|
| Rate for Payer: United Healthcare All Payer |
$12,184.27
|
|
|
JOURNEY II CSTD ARTSZ 1-2*10 L
|
Facility
|
OP
|
$13,845.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.95 |
| Max. Negotiated Rate |
$13,291.93 |
| Rate for Payer: Aetna Commercial |
$10,661.24
|
| Rate for Payer: Anthem Medicaid |
$4,761.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,799.69
|
| Rate for Payer: Cash Price |
$6,922.88
|
| Rate for Payer: Cigna Commercial |
$11,491.98
|
| Rate for Payer: First Health Commercial |
$13,153.47
|
| Rate for Payer: Humana Commercial |
$11,768.90
|
| Rate for Payer: Humana KY Medicaid |
$4,761.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,810.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,353.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,218.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,153.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,857.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,184.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,384.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,292.19
|
| Rate for Payer: PHCS Commercial |
$13,291.93
|
| Rate for Payer: United Healthcare All Payer |
$12,184.27
|
|
|
JOURNEY II CSTD ARTSZ 1-2*10 R
|
Facility
|
OP
|
$13,845.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.95 |
| Max. Negotiated Rate |
$13,291.93 |
| Rate for Payer: Aetna Commercial |
$10,661.24
|
| Rate for Payer: Anthem Medicaid |
$4,761.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,799.69
|
| Rate for Payer: Cash Price |
$6,922.88
|
| Rate for Payer: Cigna Commercial |
$11,491.98
|
| Rate for Payer: First Health Commercial |
$13,153.47
|
| Rate for Payer: Humana Commercial |
$11,768.90
|
| Rate for Payer: Humana KY Medicaid |
$4,761.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,810.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,353.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,218.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,153.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,857.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,184.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,384.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,292.19
|
| Rate for Payer: PHCS Commercial |
$13,291.93
|
| Rate for Payer: United Healthcare All Payer |
$12,184.27
|
|
|
JOURNEY II CSTD ARTSZ 1-2*10 R
|
Facility
|
IP
|
$13,845.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.95 |
| Max. Negotiated Rate |
$13,291.93 |
| Rate for Payer: Aetna Commercial |
$10,661.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,799.69
|
| Rate for Payer: Cash Price |
$6,922.88
|
| Rate for Payer: Cigna Commercial |
$11,491.98
|
| Rate for Payer: First Health Commercial |
$13,153.47
|
| Rate for Payer: Humana Commercial |
$11,768.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,353.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,218.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,153.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,184.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,384.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,292.19
|
| Rate for Payer: PHCS Commercial |
$13,291.93
|
| Rate for Payer: United Healthcare All Payer |
$12,184.27
|
|
|
JOURNEY II CSTD ARTSZ 1-2*11 L
|
Facility
|
OP
|
$13,845.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.95 |
| Max. Negotiated Rate |
$13,291.93 |
| Rate for Payer: Aetna Commercial |
$10,661.24
|
| Rate for Payer: Anthem Medicaid |
$4,761.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,799.69
|
| Rate for Payer: Cash Price |
$6,922.88
|
| Rate for Payer: Cigna Commercial |
$11,491.98
|
| Rate for Payer: First Health Commercial |
$13,153.47
|
| Rate for Payer: Humana Commercial |
$11,768.90
|
| Rate for Payer: Humana KY Medicaid |
$4,761.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,810.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,353.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,218.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,153.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,857.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,184.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,384.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,292.19
|
| Rate for Payer: PHCS Commercial |
$13,291.93
|
| Rate for Payer: United Healthcare All Payer |
$12,184.27
|
|
