|
JOURNEY II CR FEM OX NP SZ 5 L
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 5 L
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 5 R
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 5 R
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 6 L
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 6 L
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 6 R
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 6 R
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 7 L
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 7 L
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 7 R
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 7 R
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 8 L
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 8 L
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 8 R
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 8 R
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 9 L
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 9 L
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 9 R
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CR FEM OX NP SZ 9 R
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
JOURNEY II CSTD ARTSZ 1-2*10 L
|
Facility
|
IP
|
$14,103.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.06 |
| Max. Negotiated Rate |
$13,539.41 |
| Rate for Payer: Aetna Commercial |
$10,859.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,000.77
|
| Rate for Payer: Cash Price |
$7,051.77
|
| Rate for Payer: Cigna Commercial |
$11,705.95
|
| Rate for Payer: First Health Commercial |
$13,398.37
|
| Rate for Payer: Humana Commercial |
$11,988.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,564.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,411.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,577.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,282.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,270.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,731.45
|
| Rate for Payer: PHCS Commercial |
$13,539.41
|
| Rate for Payer: United Healthcare All Payer |
$12,411.12
|
|
|
JOURNEY II CSTD ARTSZ 1-2*10 L
|
Facility
|
OP
|
$14,103.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.06 |
| Max. Negotiated Rate |
$13,539.41 |
| Rate for Payer: Aetna Commercial |
$10,859.73
|
| Rate for Payer: Anthem Medicaid |
$4,850.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,000.77
|
| Rate for Payer: Cash Price |
$7,051.77
|
| Rate for Payer: Cigna Commercial |
$11,705.95
|
| Rate for Payer: First Health Commercial |
$13,398.37
|
| Rate for Payer: Humana Commercial |
$11,988.02
|
| Rate for Payer: Humana KY Medicaid |
$4,850.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,899.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,564.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,947.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,411.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,577.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,282.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,270.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,731.45
|
| Rate for Payer: PHCS Commercial |
$13,539.41
|
| Rate for Payer: United Healthcare All Payer |
$12,411.12
|
|
|
JOURNEY II CSTD ARTSZ 1-2*10 R
|
Facility
|
IP
|
$14,103.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.06 |
| Max. Negotiated Rate |
$13,539.41 |
| Rate for Payer: Aetna Commercial |
$10,859.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,000.77
|
| Rate for Payer: Cash Price |
$7,051.77
|
| Rate for Payer: Cigna Commercial |
$11,705.95
|
| Rate for Payer: First Health Commercial |
$13,398.37
|
| Rate for Payer: Humana Commercial |
$11,988.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,564.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,411.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,577.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,282.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,270.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,731.45
|
| Rate for Payer: PHCS Commercial |
$13,539.41
|
| Rate for Payer: United Healthcare All Payer |
$12,411.12
|
|
|
JOURNEY II CSTD ARTSZ 1-2*10 R
|
Facility
|
OP
|
$14,103.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.06 |
| Max. Negotiated Rate |
$13,539.41 |
| Rate for Payer: Aetna Commercial |
$10,859.73
|
| Rate for Payer: Anthem Medicaid |
$4,850.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,000.77
|
| Rate for Payer: Cash Price |
$7,051.77
|
| Rate for Payer: Cigna Commercial |
$11,705.95
|
| Rate for Payer: First Health Commercial |
$13,398.37
|
| Rate for Payer: Humana Commercial |
$11,988.02
|
| Rate for Payer: Humana KY Medicaid |
$4,850.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,899.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,564.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,947.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,411.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,577.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,282.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,270.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,731.45
|
| Rate for Payer: PHCS Commercial |
$13,539.41
|
| Rate for Payer: United Healthcare All Payer |
$12,411.12
|
|
|
JOURNEY II CSTD ARTSZ 1-2*11 L
|
Facility
|
OP
|
$14,103.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.06 |
| Max. Negotiated Rate |
$13,539.41 |
| Rate for Payer: Aetna Commercial |
$10,859.73
|
| Rate for Payer: Anthem Medicaid |
$4,850.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,000.77
|
| Rate for Payer: Cash Price |
$7,051.77
|
| Rate for Payer: Cigna Commercial |
$11,705.95
|
| Rate for Payer: First Health Commercial |
$13,398.37
|
| Rate for Payer: Humana Commercial |
$11,988.02
|
| Rate for Payer: Humana KY Medicaid |
$4,850.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,899.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,564.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,947.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,411.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,577.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,282.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,270.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,731.45
|
| Rate for Payer: PHCS Commercial |
$13,539.41
|
| Rate for Payer: United Healthcare All Payer |
$12,411.12
|
|
