|
JOURNEY TIB SZ 2 LM/RL 7MM
|
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 TIB SZ 2 LM/RL 7MM
|
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 TIB SZ 2 RM/LL 7MM
|
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 TIB SZ 2 RM/LL 7MM
|
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 TIB SZ 3 LM/RL 7MM
|
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 TIB SZ 3 LM/RL 7MM
|
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 TIB SZ 3 RM/LL 7MM
|
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 TIB SZ 3 RM/LL 7MM
|
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 TIB SZ 4 LM/RL 7MM
|
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 TIB SZ 4 LM/RL 7MM
|
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 TIB SZ 4 RM/LL 7MM
|
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 TIB SZ 4 RM/LL 7MM
|
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 TIB SZ 5 LM/RL 7MM
|
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 TIB SZ 5 LM/RL 7MM
|
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 TIB SZ 5 RM/LL 7MM
|
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 TIB SZ 5 RM/LL 7MM
|
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 TIB SZ 6 LM/RL 7MM
|
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 TIB SZ 6 LM/RL 7MM
|
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 TIB SZ 6 RM/LL 7MM
|
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 TIB SZ 6 RM/LL 7MM
|
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
|
|
|
JOURNEYTM 7.5 RND RESUR PAT 35
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
JOURNEYTM 7.5 RND RESUR PAT 35
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
JOURNEY VISIONAIRE CUT BLCK L
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
JOURNEY VISIONAIRE CUT BLCK L
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
JOURNY ARTINS BCS SM 1-2 LT 10
|
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
|
|
