|
JOURNY ART INS BCS STD 3-4 R 9
|
Facility
|
OP
|
$8,344.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.74 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Aetna Commercial |
$6,425.01
|
| Rate for Payer: Anthem Medicaid |
$2,869.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,508.45
|
| Rate for Payer: Cash Price |
$4,172.08
|
| Rate for Payer: Cigna Commercial |
$6,925.66
|
| Rate for Payer: First Health Commercial |
$7,926.96
|
| Rate for Payer: Humana Commercial |
$7,092.54
|
| Rate for Payer: Humana KY Medicaid |
$2,869.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,898.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,842.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,158.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,503.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,927.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,342.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,258.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.69
|
| Rate for Payer: PHCS Commercial |
$8,010.40
|
| Rate for Payer: United Healthcare All Payer |
$7,342.87
|
|
|
JOURNY ART INS BCS STD 3-4 R 9
|
Facility
|
IP
|
$8,344.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.74 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Aetna Commercial |
$6,425.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,508.45
|
| Rate for Payer: Cash Price |
$4,172.08
|
| Rate for Payer: Cigna Commercial |
$6,925.66
|
| Rate for Payer: First Health Commercial |
$7,926.96
|
| Rate for Payer: Humana Commercial |
$7,092.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,842.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,158.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,503.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,342.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,258.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.69
|
| Rate for Payer: PHCS Commercial |
$8,010.40
|
| Rate for Payer: United Healthcare All Payer |
$7,342.87
|
|
|
JOURNY ARTINS BCS STD 5-6 L10
|
Facility
|
OP
|
$8,344.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.74 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Aetna Commercial |
$6,425.01
|
| Rate for Payer: Anthem Medicaid |
$2,869.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,508.45
|
| Rate for Payer: Cash Price |
$4,172.08
|
| Rate for Payer: Cigna Commercial |
$6,925.66
|
| Rate for Payer: First Health Commercial |
$7,926.96
|
| Rate for Payer: Humana Commercial |
$7,092.54
|
| Rate for Payer: Humana KY Medicaid |
$2,869.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,898.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,842.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,158.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,503.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,927.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,342.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,258.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.69
|
| Rate for Payer: PHCS Commercial |
$8,010.40
|
| Rate for Payer: United Healthcare All Payer |
$7,342.87
|
|
|
JOURNY ARTINS BCS STD 5-6 L10
|
Facility
|
IP
|
$8,344.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.74 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Aetna Commercial |
$6,425.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,508.45
|
| Rate for Payer: Cash Price |
$4,172.08
|
| Rate for Payer: Cigna Commercial |
$6,925.66
|
| Rate for Payer: First Health Commercial |
$7,926.96
|
| Rate for Payer: Humana Commercial |
$7,092.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,842.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,158.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,503.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,342.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,258.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.69
|
| Rate for Payer: PHCS Commercial |
$8,010.40
|
| Rate for Payer: United Healthcare All Payer |
$7,342.87
|
|
|
JOURNY ARTINS BCS STD 5-6 L11
|
Facility
|
OP
|
$8,344.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.74 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Aetna Commercial |
$6,425.01
|
| Rate for Payer: Anthem Medicaid |
$2,869.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,508.45
|
| Rate for Payer: Cash Price |
$4,172.08
|
| Rate for Payer: Cigna Commercial |
$6,925.66
|
| Rate for Payer: First Health Commercial |
$7,926.96
|
| Rate for Payer: Humana Commercial |
$7,092.54
|
| Rate for Payer: Humana KY Medicaid |
$2,869.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,898.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,842.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,158.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,503.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,927.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,342.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,258.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.69
|
| Rate for Payer: PHCS Commercial |
$8,010.40
|
| Rate for Payer: United Healthcare All Payer |
$7,342.87
|
|
|
JOURNY ARTINS BCS STD 5-6 L11
|
Facility
|
IP
|
$8,344.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.74 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Aetna Commercial |
$6,425.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,508.45
|
| Rate for Payer: Cash Price |
$4,172.08
|
| Rate for Payer: Cigna Commercial |
$6,925.66
|
| Rate for Payer: First Health Commercial |
$7,926.96
|
| Rate for Payer: Humana Commercial |
$7,092.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,842.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,158.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,503.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,342.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,258.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.69
|
| Rate for Payer: PHCS Commercial |
$8,010.40
|
| Rate for Payer: United Healthcare All Payer |
$7,342.87
|
|
|
JOURNY ARTINS BCS STD 5-6 L13
|
Facility
|
IP
|
$6,596.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.48 |
| Max. Negotiated Rate |
$6,332.16 |
| Rate for Payer: Aetna Commercial |
$5,078.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,144.88
|
| Rate for Payer: Cash Price |
$3,298.00
|
| Rate for Payer: Cigna Commercial |
$5,474.68
|
| Rate for Payer: First Health Commercial |
$6,266.20
|
| Rate for Payer: Humana Commercial |
$5,606.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,408.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,867.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,978.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,804.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,947.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,319.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,044.76
|
| Rate for Payer: PHCS Commercial |
$6,332.16
|
| Rate for Payer: United Healthcare All Payer |
$5,804.48
|
|
|
JOURNY ARTINS BCS STD 5-6 L13
|
Facility
|
OP
|
$6,596.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.48 |
| Max. Negotiated Rate |
$6,332.16 |
| Rate for Payer: Aetna Commercial |
$5,078.92
|
| Rate for Payer: Anthem Medicaid |
$2,268.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,144.88
|
| Rate for Payer: Cash Price |
$3,298.00
|
| Rate for Payer: Cigna Commercial |
$5,474.68
|
| Rate for Payer: First Health Commercial |
$6,266.20
|
| Rate for Payer: Humana Commercial |
$5,606.60
|
| Rate for Payer: Humana KY Medicaid |
$2,268.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,291.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,408.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,867.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,978.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,313.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,804.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,947.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,319.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,044.76
|
| Rate for Payer: PHCS Commercial |
$6,332.16
|
| Rate for Payer: United Healthcare All Payer |
$5,804.48
|
|
|
JOURNY ARTINS BCS STD 5-6 L15
|
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
|
|
|
JOURNY ARTINS BCS STD 5-6 L15
|
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
|
|
|
JOURNY ARTINS BCS STD 5-6 L18
|
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
|
|
|
JOURNY ARTINS BCS STD 5-6 L18
|
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
|
|
|
JOURNY ARTINS BCS STD 5-6 L21
|
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
|
|
|
JOURNY ARTINS BCS STD 5-6 L21
|
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
|
|
|
JOURNY ARTINS BCS STD 5-6 L25
|
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
|
|
|
JOURNY ARTINS BCS STD 5-6 L25
|
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
|
|
|
JOURNY ART INS BCS STD 5-6 L 9
|
Facility
|
OP
|
$8,344.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.74 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Aetna Commercial |
$6,425.01
|
| Rate for Payer: Anthem Medicaid |
$2,869.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,508.45
|
| Rate for Payer: Cash Price |
$4,172.08
|
| Rate for Payer: Cigna Commercial |
$6,925.66
|
| Rate for Payer: First Health Commercial |
$7,926.96
|
| Rate for Payer: Humana Commercial |
$7,092.54
|
| Rate for Payer: Humana KY Medicaid |
$2,869.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,898.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,842.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,158.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,503.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,927.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,342.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,258.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.69
|
| Rate for Payer: PHCS Commercial |
$8,010.40
|
| Rate for Payer: United Healthcare All Payer |
$7,342.87
|
|
|
JOURNY ART INS BCS STD 5-6 L 9
|
Facility
|
IP
|
$8,344.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.74 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Aetna Commercial |
$6,425.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,508.45
|
| Rate for Payer: Cash Price |
$4,172.08
|
| Rate for Payer: Cigna Commercial |
$6,925.66
|
| Rate for Payer: First Health Commercial |
$7,926.96
|
| Rate for Payer: Humana Commercial |
$7,092.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,842.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,158.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,503.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,342.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,258.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.69
|
| Rate for Payer: PHCS Commercial |
$8,010.40
|
| Rate for Payer: United Healthcare All Payer |
$7,342.87
|
|
|
JOURNY ARTINS BCS STD 5-6 R 10
|
Facility
|
IP
|
$8,344.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.74 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Aetna Commercial |
$6,425.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,508.45
|
| Rate for Payer: Cash Price |
$4,172.08
|
| Rate for Payer: Cigna Commercial |
$6,925.66
|
| Rate for Payer: First Health Commercial |
$7,926.96
|
| Rate for Payer: Humana Commercial |
$7,092.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,842.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,158.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,503.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,342.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,258.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.69
|
| Rate for Payer: PHCS Commercial |
$8,010.40
|
| Rate for Payer: United Healthcare All Payer |
$7,342.87
|
|
|
JOURNY ARTINS BCS STD 5-6 R 10
|
Facility
|
OP
|
$8,344.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.74 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Aetna Commercial |
$6,425.01
|
| Rate for Payer: Anthem Medicaid |
$2,869.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,508.45
|
| Rate for Payer: Cash Price |
$4,172.08
|
| Rate for Payer: Cigna Commercial |
$6,925.66
|
| Rate for Payer: First Health Commercial |
$7,926.96
|
| Rate for Payer: Humana Commercial |
$7,092.54
|
| Rate for Payer: Humana KY Medicaid |
$2,869.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,898.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,842.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,158.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,503.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,927.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,342.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,258.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.69
|
| Rate for Payer: PHCS Commercial |
$8,010.40
|
| Rate for Payer: United Healthcare All Payer |
$7,342.87
|
|
|
JOURNY ARTINS BCS STD 5-6 R 11
|
Facility
|
IP
|
$6,596.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.48 |
| Max. Negotiated Rate |
$6,332.16 |
| Rate for Payer: Aetna Commercial |
$5,078.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,144.88
|
| Rate for Payer: Cash Price |
$3,298.00
|
| Rate for Payer: Cigna Commercial |
$5,474.68
|
| Rate for Payer: First Health Commercial |
$6,266.20
|
| Rate for Payer: Humana Commercial |
$5,606.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,408.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,867.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,978.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,804.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,947.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,319.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,044.76
|
| Rate for Payer: PHCS Commercial |
$6,332.16
|
| Rate for Payer: United Healthcare All Payer |
$5,804.48
|
|
|
JOURNY ARTINS BCS STD 5-6 R 11
|
Facility
|
OP
|
$6,596.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.48 |
| Max. Negotiated Rate |
$6,332.16 |
| Rate for Payer: Aetna Commercial |
$5,078.92
|
| Rate for Payer: Anthem Medicaid |
$2,268.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,144.88
|
| Rate for Payer: Cash Price |
$3,298.00
|
| Rate for Payer: Cigna Commercial |
$5,474.68
|
| Rate for Payer: First Health Commercial |
$6,266.20
|
| Rate for Payer: Humana Commercial |
$5,606.60
|
| Rate for Payer: Humana KY Medicaid |
$2,268.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,291.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,408.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,867.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,978.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,313.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,804.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,947.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,319.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,044.76
|
| Rate for Payer: PHCS Commercial |
$6,332.16
|
| Rate for Payer: United Healthcare All Payer |
$5,804.48
|
|
|
JOURNY ARTINS BCS STD 5-6 R 13
|
Facility
|
IP
|
$8,344.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.74 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Aetna Commercial |
$6,425.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,508.45
|
| Rate for Payer: Cash Price |
$4,172.08
|
| Rate for Payer: Cigna Commercial |
$6,925.66
|
| Rate for Payer: First Health Commercial |
$7,926.96
|
| Rate for Payer: Humana Commercial |
$7,092.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,842.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,158.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,503.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,342.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,258.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.69
|
| Rate for Payer: PHCS Commercial |
$8,010.40
|
| Rate for Payer: United Healthcare All Payer |
$7,342.87
|
|
|
JOURNY ARTINS BCS STD 5-6 R 13
|
Facility
|
OP
|
$8,344.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.74 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Aetna Commercial |
$6,425.01
|
| Rate for Payer: Anthem Medicaid |
$2,869.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,508.45
|
| Rate for Payer: Cash Price |
$4,172.08
|
| Rate for Payer: Cigna Commercial |
$6,925.66
|
| Rate for Payer: First Health Commercial |
$7,926.96
|
| Rate for Payer: Humana Commercial |
$7,092.54
|
| Rate for Payer: Humana KY Medicaid |
$2,869.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,898.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,842.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,158.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,503.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,927.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,342.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,258.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,668.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,586.69
|
| Rate for Payer: PHCS Commercial |
$8,010.40
|
| Rate for Payer: United Healthcare All Payer |
$7,342.87
|
|
|
JOURNY ARTINS BCS STD 5-6 R 15
|
Facility
|
OP
|
$6,596.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.48 |
| Max. Negotiated Rate |
$6,332.16 |
| Rate for Payer: Aetna Commercial |
$5,078.92
|
| Rate for Payer: Anthem Medicaid |
$2,268.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,144.88
|
| Rate for Payer: Cash Price |
$3,298.00
|
| Rate for Payer: Cigna Commercial |
$5,474.68
|
| Rate for Payer: First Health Commercial |
$6,266.20
|
| Rate for Payer: Humana Commercial |
$5,606.60
|
| Rate for Payer: Humana KY Medicaid |
$2,268.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,291.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,408.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,867.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,978.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,313.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,804.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,947.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,319.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,044.76
|
| Rate for Payer: PHCS Commercial |
$6,332.16
|
| Rate for Payer: United Healthcare All Payer |
$5,804.48
|
|
