|
JOURNEY II CSTD ARTSZ 1-2*11 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*11 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*11 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 ART SZ 1-2*12L
|
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 ART SZ 1-2*12L
|
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*12 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*12 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*13 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*13 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*13 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*13 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*15 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*15 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*15 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*15 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*18 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*18 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*18 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*18 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*21 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*21 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*21 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*21 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*25 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*25 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
|
|
