|
JOURNEY POLY TIB 4RM/LL 10MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 4RM/LL 10MM
|
Facility
|
IP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 4RM/LL 11MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 4RM/LL 11MM
|
Facility
|
IP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 4RM/LL 8MM
|
Facility
|
IP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 4RM/LL 8MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 4RM/LL 9MM
|
Facility
|
IP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 4RM/LL 9MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5LM/RL 10MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5LM/RL 10MM
|
Facility
|
IP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5LM/RL 11MM
|
Facility
|
IP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5LM/RL 11MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5LM/RL 8MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5LM/RL 8MM
|
Facility
|
IP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5LM/RL 9MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5LM/RL 9MM
|
Facility
|
IP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5RM/LL 10MM
|
Facility
|
IP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5RM/LL 10MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5RM/LL 11MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5RM/LL 11MM
|
Facility
|
IP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5RM/LL 8MM
|
Facility
|
IP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5RM/LL 8MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5RM/LL 9MM
|
Facility
|
IP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 5RM/LL 9MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
|
JOURNEY POLY TIB 6LM/RL 10MM
|
Facility
|
OP
|
$9,346.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.02 |
| Max. Negotiated Rate |
$8,972.42 |
| Rate for Payer: Aetna Commercial |
$7,196.63
|
| Rate for Payer: Anthem Medicaid |
$3,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,290.09
|
| Rate for Payer: Cash Price |
$4,673.14
|
| Rate for Payer: Cigna Commercial |
$7,757.40
|
| Rate for Payer: First Health Commercial |
$8,878.96
|
| Rate for Payer: Humana Commercial |
$7,944.33
|
| Rate for Payer: Humana KY Medicaid |
$3,214.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,246.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,663.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,897.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,803.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,278.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,224.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,009.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,869.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.34
|
| Rate for Payer: PHCS Commercial |
$8,972.42
|
| Rate for Payer: United Healthcare All Payer |
$8,224.72
|
|
