|
JOURNEY II CSTD ARTSZ 7-8*21 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 7-8*21 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 7-8*21 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 7-8*21 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 7-8*25 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 7-8*25 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 ART SZ 7-8*9 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 ART SZ 7-8*9 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 ART SZ 7-8*9 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 ART SZ 7-8*9 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 OX TROCH X-SM RT
|
Facility
|
OP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem Medicaid |
$3,790.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Humana KY Medicaid |
$3,790.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,829.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,867.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
JOURNEY OX TROCH X-SM RT
|
Facility
|
IP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
JOURNEY PAT BICONVEX 23MM SM
|
Facility
|
OP
|
$5,174.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.42 |
| Max. Negotiated Rate |
$4,967.76 |
| Rate for Payer: Aetna Commercial |
$3,984.56
|
| Rate for Payer: Anthem Medicaid |
$1,779.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.30
|
| Rate for Payer: Cash Price |
$2,587.38
|
| Rate for Payer: Cigna Commercial |
$4,295.04
|
| Rate for Payer: First Health Commercial |
$4,916.01
|
| Rate for Payer: Humana Commercial |
$4,398.54
|
| Rate for Payer: Humana KY Medicaid |
$1,779.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,815.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,553.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,881.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,139.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,502.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,570.58
|
| Rate for Payer: PHCS Commercial |
$4,967.76
|
| Rate for Payer: United Healthcare All Payer |
$4,553.78
|
|
|
JOURNEY PAT BICONVEX 23MM SM
|
Facility
|
IP
|
$5,174.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.42 |
| Max. Negotiated Rate |
$4,967.76 |
| Rate for Payer: Aetna Commercial |
$3,984.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.30
|
| Rate for Payer: Cash Price |
$2,587.38
|
| Rate for Payer: Cigna Commercial |
$4,295.04
|
| Rate for Payer: First Health Commercial |
$4,916.01
|
| Rate for Payer: Humana Commercial |
$4,398.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,553.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,881.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,139.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,502.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,570.58
|
| Rate for Payer: PHCS Commercial |
$4,967.76
|
| Rate for Payer: United Healthcare All Payer |
$4,553.78
|
|
|
JOURNEY PAT BICONVEX 23MM STD
|
Facility
|
IP
|
$4,180.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,254.03 |
| Max. Negotiated Rate |
$4,012.90 |
| Rate for Payer: Aetna Commercial |
$3,218.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,260.48
|
| Rate for Payer: Cash Price |
$2,090.05
|
| Rate for Payer: Cigna Commercial |
$3,469.48
|
| Rate for Payer: First Health Commercial |
$3,971.09
|
| Rate for Payer: Humana Commercial |
$3,553.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,427.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,084.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,254.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,678.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,135.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,344.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,636.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,884.27
|
| Rate for Payer: PHCS Commercial |
$4,012.90
|
| Rate for Payer: United Healthcare All Payer |
$3,678.49
|
|
|
JOURNEY PAT BICONVEX 23MM STD
|
Facility
|
OP
|
$4,180.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,254.03 |
| Max. Negotiated Rate |
$4,012.90 |
| Rate for Payer: Aetna Commercial |
$3,218.68
|
| Rate for Payer: Anthem Medicaid |
$1,437.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,260.48
|
| Rate for Payer: Cash Price |
$2,090.05
|
| Rate for Payer: Cigna Commercial |
$3,469.48
|
| Rate for Payer: First Health Commercial |
$3,971.09
|
| Rate for Payer: Humana Commercial |
$3,553.09
|
| Rate for Payer: Humana KY Medicaid |
$1,437.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,452.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,427.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,084.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,254.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,466.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,678.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,135.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,344.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,636.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,884.27
|
| Rate for Payer: PHCS Commercial |
$4,012.90
|
| Rate for Payer: United Healthcare All Payer |
$3,678.49
|
|
|
JOURNEY PAT BICONVEX 26MM SM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY PAT BICONVEX 26MM SM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY PAT BICONVEX 26MM STD
|
Facility
|
OP
|
$5,174.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.42 |
| Max. Negotiated Rate |
$4,967.76 |
| Rate for Payer: Aetna Commercial |
$3,984.56
|
| Rate for Payer: Anthem Medicaid |
$1,779.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.30
|
| Rate for Payer: Cash Price |
$2,587.38
|
| Rate for Payer: Cigna Commercial |
$4,295.04
|
| Rate for Payer: First Health Commercial |
$4,916.01
|
| Rate for Payer: Humana Commercial |
$4,398.54
|
| Rate for Payer: Humana KY Medicaid |
$1,779.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,815.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,553.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,881.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,139.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,502.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,570.58
|
| Rate for Payer: PHCS Commercial |
$4,967.76
|
| Rate for Payer: United Healthcare All Payer |
$4,553.78
|
|
|
JOURNEY PAT BICONVEX 26MM STD
|
Facility
|
IP
|
$5,174.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.42 |
| Max. Negotiated Rate |
$4,967.76 |
| Rate for Payer: Aetna Commercial |
$3,984.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.30
|
| Rate for Payer: Cash Price |
$2,587.38
|
| Rate for Payer: Cigna Commercial |
$4,295.04
|
| Rate for Payer: First Health Commercial |
$4,916.01
|
| Rate for Payer: Humana Commercial |
$4,398.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,553.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,881.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,139.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,502.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,570.58
|
| Rate for Payer: PHCS Commercial |
$4,967.76
|
| Rate for Payer: United Healthcare All Payer |
$4,553.78
|
|
|
JOURNEY PAT BICONVEX 29MM SM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY PAT BICONVEX 29MM SM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
JOURNEY PAT BICONVEX 29MM STD
|
Facility
|
OP
|
$5,174.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.42 |
| Max. Negotiated Rate |
$4,967.76 |
| Rate for Payer: Aetna Commercial |
$3,984.56
|
| Rate for Payer: Anthem Medicaid |
$1,779.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.30
|
| Rate for Payer: Cash Price |
$2,587.38
|
| Rate for Payer: Cigna Commercial |
$4,295.04
|
| Rate for Payer: First Health Commercial |
$4,916.01
|
| Rate for Payer: Humana Commercial |
$4,398.54
|
| Rate for Payer: Humana KY Medicaid |
$1,779.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,815.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,553.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,881.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,139.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,502.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,570.58
|
| Rate for Payer: PHCS Commercial |
$4,967.76
|
| Rate for Payer: United Healthcare All Payer |
$4,553.78
|
|
|
JOURNEY PAT BICONVEX 29MM STD
|
Facility
|
IP
|
$5,174.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.42 |
| Max. Negotiated Rate |
$4,967.76 |
| Rate for Payer: Aetna Commercial |
$3,984.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.30
|
| Rate for Payer: Cash Price |
$2,587.38
|
| Rate for Payer: Cigna Commercial |
$4,295.04
|
| Rate for Payer: First Health Commercial |
$4,916.01
|
| Rate for Payer: Humana Commercial |
$4,398.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,553.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,881.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,139.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,502.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,570.58
|
| Rate for Payer: PHCS Commercial |
$4,967.76
|
| Rate for Payer: United Healthcare All Payer |
$4,553.78
|
|
|
JOURNEY PAT BICONVEX 32MM STD
|
Facility
|
OP
|
$5,174.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.42 |
| Max. Negotiated Rate |
$4,967.76 |
| Rate for Payer: Aetna Commercial |
$3,984.56
|
| Rate for Payer: Anthem Medicaid |
$1,779.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.30
|
| Rate for Payer: Cash Price |
$2,587.38
|
| Rate for Payer: Cigna Commercial |
$4,295.04
|
| Rate for Payer: First Health Commercial |
$4,916.01
|
| Rate for Payer: Humana Commercial |
$4,398.54
|
| Rate for Payer: Humana KY Medicaid |
$1,779.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,815.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,553.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,881.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,139.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,502.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,570.58
|
| Rate for Payer: PHCS Commercial |
$4,967.76
|
| Rate for Payer: United Healthcare All Payer |
$4,553.78
|
|
