|
JOURNEY FEM OX NP BCS RT 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 RT 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 RT 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 RT 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 RT 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 RT 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 RT 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 RT 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 RT SZ 9
|
Facility
|
OP
|
$22,636.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,790.93 |
| Max. Negotiated Rate |
$21,730.98 |
| Rate for Payer: Aetna Commercial |
$17,430.06
|
| Rate for Payer: Anthem Medicaid |
$7,784.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,656.42
|
| Rate for Payer: Cash Price |
$11,318.22
|
| Rate for Payer: Cigna Commercial |
$18,788.25
|
| Rate for Payer: First Health Commercial |
$21,504.62
|
| Rate for Payer: Humana Commercial |
$19,240.97
|
| Rate for Payer: Humana KY Medicaid |
$7,784.67
|
| Rate for Payer: Kentucky WC Medicaid |
$7,863.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,561.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,705.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,790.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,940.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,920.07
|
| Rate for Payer: Ohio Health Group HMO |
$16,977.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,109.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,693.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,619.14
|
| Rate for Payer: PHCS Commercial |
$21,730.98
|
| Rate for Payer: United Healthcare All Payer |
$19,920.07
|
|
|
JOURNEY FEM OX NP BCS RT SZ 9
|
Facility
|
IP
|
$22,636.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,790.93 |
| Max. Negotiated Rate |
$21,730.98 |
| Rate for Payer: Aetna Commercial |
$17,430.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,656.42
|
| Rate for Payer: Cash Price |
$11,318.22
|
| Rate for Payer: Cigna Commercial |
$18,788.25
|
| Rate for Payer: First Health Commercial |
$21,504.62
|
| Rate for Payer: Humana Commercial |
$19,240.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,561.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,705.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,790.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,920.07
|
| Rate for Payer: Ohio Health Group HMO |
$16,977.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,109.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,693.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,619.14
|
| Rate for Payer: PHCS Commercial |
$21,730.98
|
| Rate for Payer: United Healthcare All Payer |
$19,920.07
|
|
|
JOURNEY II BCS FEM COCR SZ 1 L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 1 L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 1 R
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 1 R
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 2 L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 2 L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 2 R
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 2 R
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 3 L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 3 L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 3 R
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 3 R
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 4 L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 4 L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY II BCS FEM COCR SZ 5 L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
