|
JOURNEY TIB BASE LM/RL SZ 6
|
Facility
|
IP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE LM/RL SZ 6
|
Facility
|
OP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem Medicaid |
$2,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Humana KY Medicaid |
$2,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE RM/LL SZ 1
|
Facility
|
IP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE RM/LL SZ 1
|
Facility
|
OP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem Medicaid |
$2,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Humana KY Medicaid |
$2,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE RM/LL SZ 2
|
Facility
|
OP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem Medicaid |
$2,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Humana KY Medicaid |
$2,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE RM/LL SZ 2
|
Facility
|
IP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE RM/LL SZ 3
|
Facility
|
OP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem Medicaid |
$2,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Humana KY Medicaid |
$2,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE RM/LL SZ 3
|
Facility
|
IP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE RM/LL SZ 4
|
Facility
|
IP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE RM/LL SZ 4
|
Facility
|
OP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem Medicaid |
$2,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Humana KY Medicaid |
$2,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE RM/LL SZ 5
|
Facility
|
OP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem Medicaid |
$2,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Humana KY Medicaid |
$2,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE RM/LL SZ 5
|
Facility
|
IP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE RM/LL SZ 6
|
Facility
|
IP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIB BASE RM/LL SZ 6
|
Facility
|
OP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem Medicaid |
$2,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Humana KY Medicaid |
$2,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNEY TIBIA BASE NP LT SZ 1
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
JOURNEY TIBIA BASE NP LT SZ 1
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
JOURNEY TIBIA BASE NP LT SZ 2
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
JOURNEY TIBIA BASE NP LT SZ 2
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
JOURNEY TIBIA BASE NP LT SZ 3
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
JOURNEY TIBIA BASE NP LT SZ 3
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
JOURNEY TIBIA BASE NP LT SZ 4
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
JOURNEY TIBIA BASE NP LT SZ 4
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
JOURNEY TIBIA BASE NP LT SZ 5
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
JOURNEY TIBIA BASE NP LT SZ 5
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
JOURNEY TIBIA BASE NP LT SZ 6
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
