|
JOURNEY FEM OX NP BCS LT SZ 2
|
Facility
|
OP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem Medicaid |
$7,513.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Humana KY Medicaid |
$7,513.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7,590.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,664.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS LT SZ 3
|
Facility
|
OP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem Medicaid |
$7,513.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Humana KY Medicaid |
$7,513.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7,590.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,664.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS LT SZ 3
|
Facility
|
IP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS LT SZ 4
|
Facility
|
OP
|
$15,790.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.02 |
| Max. Negotiated Rate |
$15,158.48 |
| Rate for Payer: Aetna Commercial |
$12,158.36
|
| Rate for Payer: Anthem Medicaid |
$5,430.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.26
|
| Rate for Payer: Cash Price |
$7,895.04
|
| Rate for Payer: Cigna Commercial |
$13,105.77
|
| Rate for Payer: First Health Commercial |
$15,000.58
|
| Rate for Payer: Humana Commercial |
$13,421.57
|
| Rate for Payer: Humana KY Medicaid |
$5,430.21
|
| Rate for Payer: Kentucky WC Medicaid |
$5,485.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,947.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,539.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.27
|
| Rate for Payer: Ohio Health Group HMO |
$11,842.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,737.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.16
|
| Rate for Payer: PHCS Commercial |
$15,158.48
|
| Rate for Payer: United Healthcare All Payer |
$13,895.27
|
|
|
JOURNEY FEM OX NP BCS LT SZ 4
|
Facility
|
IP
|
$15,790.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.02 |
| Max. Negotiated Rate |
$15,158.48 |
| Rate for Payer: Aetna Commercial |
$12,158.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.26
|
| Rate for Payer: Cash Price |
$7,895.04
|
| Rate for Payer: Cigna Commercial |
$13,105.77
|
| Rate for Payer: First Health Commercial |
$15,000.58
|
| Rate for Payer: Humana Commercial |
$13,421.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,947.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.27
|
| Rate for Payer: Ohio Health Group HMO |
$11,842.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,737.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.16
|
| Rate for Payer: PHCS Commercial |
$15,158.48
|
| Rate for Payer: United Healthcare All Payer |
$13,895.27
|
|
|
JOURNEY FEM OX NP BCS LT SZ 5
|
Facility
|
OP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem Medicaid |
$7,513.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Humana KY Medicaid |
$7,513.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7,590.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,664.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS LT SZ 5
|
Facility
|
IP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS LT SZ 6
|
Facility
|
IP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS LT SZ 6
|
Facility
|
OP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem Medicaid |
$7,513.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Humana KY Medicaid |
$7,513.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7,590.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,664.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS LT SZ 7
|
Facility
|
OP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem Medicaid |
$7,513.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Humana KY Medicaid |
$7,513.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7,590.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,664.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS LT SZ 7
|
Facility
|
IP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS LT SZ 8
|
Facility
|
IP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS LT SZ 8
|
Facility
|
OP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem Medicaid |
$7,513.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Humana KY Medicaid |
$7,513.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7,590.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,664.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS LT SZ 9
|
Facility
|
OP
|
$14,363.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,308.96 |
| Max. Negotiated Rate |
$13,788.67 |
| Rate for Payer: Aetna Commercial |
$11,059.66
|
| Rate for Payer: Anthem Medicaid |
$4,939.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,203.30
|
| Rate for Payer: Cash Price |
$7,181.60
|
| Rate for Payer: Cigna Commercial |
$11,921.46
|
| Rate for Payer: First Health Commercial |
$13,645.04
|
| Rate for Payer: Humana Commercial |
$12,208.72
|
| Rate for Payer: Humana KY Medicaid |
$4,939.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,989.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,777.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,600.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,308.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,038.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,639.62
|
| Rate for Payer: Ohio Health Group HMO |
$10,772.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,490.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,495.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,910.61
|
| Rate for Payer: PHCS Commercial |
$13,788.67
|
| Rate for Payer: United Healthcare All Payer |
$12,639.62
|
|
|
JOURNEY FEM OX NP BCS LT SZ 9
|
Facility
|
IP
|
$14,363.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,308.96 |
| Max. Negotiated Rate |
$13,788.67 |
| Rate for Payer: Aetna Commercial |
$11,059.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,203.30
|
| Rate for Payer: Cash Price |
$7,181.60
|
| Rate for Payer: Cigna Commercial |
$11,921.46
|
| Rate for Payer: First Health Commercial |
$13,645.04
|
| Rate for Payer: Humana Commercial |
$12,208.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,777.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,600.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,308.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,639.62
|
| Rate for Payer: Ohio Health Group HMO |
$10,772.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,490.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,495.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,910.61
|
| Rate for Payer: PHCS Commercial |
$13,788.67
|
| Rate for Payer: United Healthcare All Payer |
$12,639.62
|
|
|
JOURNEY FEM OX NP BCS RT SZ 1
|
Facility
|
IP
|
$14,363.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,308.96 |
| Max. Negotiated Rate |
$13,788.67 |
| Rate for Payer: Aetna Commercial |
$11,059.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,203.30
|
| Rate for Payer: Cash Price |
$7,181.60
|
| Rate for Payer: Cigna Commercial |
$11,921.46
|
| Rate for Payer: First Health Commercial |
$13,645.04
|
| Rate for Payer: Humana Commercial |
$12,208.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,777.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,600.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,308.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,639.62
|
| Rate for Payer: Ohio Health Group HMO |
$10,772.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,490.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,495.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,910.61
|
| Rate for Payer: PHCS Commercial |
$13,788.67
|
| Rate for Payer: United Healthcare All Payer |
$12,639.62
|
|
|
JOURNEY FEM OX NP BCS RT SZ 1
|
Facility
|
OP
|
$14,363.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,308.96 |
| Max. Negotiated Rate |
$13,788.67 |
| Rate for Payer: Aetna Commercial |
$11,059.66
|
| Rate for Payer: Anthem Medicaid |
$4,939.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,203.30
|
| Rate for Payer: Cash Price |
$7,181.60
|
| Rate for Payer: Cigna Commercial |
$11,921.46
|
| Rate for Payer: First Health Commercial |
$13,645.04
|
| Rate for Payer: Humana Commercial |
$12,208.72
|
| Rate for Payer: Humana KY Medicaid |
$4,939.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,989.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,777.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,600.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,308.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,038.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,639.62
|
| Rate for Payer: Ohio Health Group HMO |
$10,772.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,490.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,495.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,910.61
|
| Rate for Payer: PHCS Commercial |
$13,788.67
|
| Rate for Payer: United Healthcare All Payer |
$12,639.62
|
|
|
JOURNEY FEM OX NP BCS RT SZ 10
|
Facility
|
OP
|
$14,363.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,308.96 |
| Max. Negotiated Rate |
$13,788.67 |
| Rate for Payer: Aetna Commercial |
$11,059.66
|
| Rate for Payer: Anthem Medicaid |
$4,939.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,203.30
|
| Rate for Payer: Cash Price |
$7,181.60
|
| Rate for Payer: Cigna Commercial |
$11,921.46
|
| Rate for Payer: First Health Commercial |
$13,645.04
|
| Rate for Payer: Humana Commercial |
$12,208.72
|
| Rate for Payer: Humana KY Medicaid |
$4,939.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,989.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,777.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,600.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,308.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,038.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,639.62
|
| Rate for Payer: Ohio Health Group HMO |
$10,772.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,490.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,495.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,910.61
|
| Rate for Payer: PHCS Commercial |
$13,788.67
|
| Rate for Payer: United Healthcare All Payer |
$12,639.62
|
|
|
JOURNEY FEM OX NP BCS RT SZ 10
|
Facility
|
IP
|
$14,363.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,308.96 |
| Max. Negotiated Rate |
$13,788.67 |
| Rate for Payer: Aetna Commercial |
$11,059.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,203.30
|
| Rate for Payer: Cash Price |
$7,181.60
|
| Rate for Payer: Cigna Commercial |
$11,921.46
|
| Rate for Payer: First Health Commercial |
$13,645.04
|
| Rate for Payer: Humana Commercial |
$12,208.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,777.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,600.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,308.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,639.62
|
| Rate for Payer: Ohio Health Group HMO |
$10,772.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,490.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,495.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,910.61
|
| Rate for Payer: PHCS Commercial |
$13,788.67
|
| Rate for Payer: United Healthcare All Payer |
$12,639.62
|
|
|
JOURNEY FEM OX NP BCS RT SZ 2
|
Facility
|
IP
|
$15,790.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.02 |
| Max. Negotiated Rate |
$15,158.48 |
| Rate for Payer: Aetna Commercial |
$12,158.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.26
|
| Rate for Payer: Cash Price |
$7,895.04
|
| Rate for Payer: Cigna Commercial |
$13,105.77
|
| Rate for Payer: First Health Commercial |
$15,000.58
|
| Rate for Payer: Humana Commercial |
$13,421.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,947.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.27
|
| Rate for Payer: Ohio Health Group HMO |
$11,842.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,737.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.16
|
| Rate for Payer: PHCS Commercial |
$15,158.48
|
| Rate for Payer: United Healthcare All Payer |
$13,895.27
|
|
|
JOURNEY FEM OX NP BCS RT SZ 2
|
Facility
|
OP
|
$15,790.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.02 |
| Max. Negotiated Rate |
$15,158.48 |
| Rate for Payer: Aetna Commercial |
$12,158.36
|
| Rate for Payer: Anthem Medicaid |
$5,430.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.26
|
| Rate for Payer: Cash Price |
$7,895.04
|
| Rate for Payer: Cigna Commercial |
$13,105.77
|
| Rate for Payer: First Health Commercial |
$15,000.58
|
| Rate for Payer: Humana Commercial |
$13,421.57
|
| Rate for Payer: Humana KY Medicaid |
$5,430.21
|
| Rate for Payer: Kentucky WC Medicaid |
$5,485.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,947.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,539.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.27
|
| Rate for Payer: Ohio Health Group HMO |
$11,842.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,737.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.16
|
| Rate for Payer: PHCS Commercial |
$15,158.48
|
| Rate for Payer: United Healthcare All Payer |
$13,895.27
|
|
|
JOURNEY FEM OX NP BCS RT SZ 3
|
Facility
|
OP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem Medicaid |
$7,513.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Humana KY Medicaid |
$7,513.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7,590.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,664.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS RT SZ 3
|
Facility
|
IP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS RT SZ 4
|
Facility
|
IP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
|
JOURNEY FEM OX NP BCS RT SZ 4
|
Facility
|
OP
|
$21,849.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,554.74 |
| Max. Negotiated Rate |
$20,975.16 |
| Rate for Payer: Aetna Commercial |
$16,823.82
|
| Rate for Payer: Anthem Medicaid |
$7,513.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,042.31
|
| Rate for Payer: Cash Price |
$10,924.56
|
| Rate for Payer: Cigna Commercial |
$18,134.77
|
| Rate for Payer: First Health Commercial |
$20,756.66
|
| Rate for Payer: Humana Commercial |
$18,571.75
|
| Rate for Payer: Humana KY Medicaid |
$7,513.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7,590.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,916.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,124.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,554.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,664.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,227.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,386.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,479.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,008.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,075.89
|
| Rate for Payer: PHCS Commercial |
$20,975.16
|
| Rate for Payer: United Healthcare All Payer |
$19,227.23
|
|
