|
JOURNEY PAT BICONVEX 32MM 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 RESRF RD 26MM SM
|
Facility
|
IP
|
$4,096.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.88 |
| Max. Negotiated Rate |
$3,932.40 |
| Rate for Payer: Aetna Commercial |
$3,154.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.07
|
| Rate for Payer: Cash Price |
$2,048.12
|
| Rate for Payer: Cigna Commercial |
$3,399.89
|
| Rate for Payer: First Health Commercial |
$3,891.44
|
| Rate for Payer: Humana Commercial |
$3,481.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,358.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,228.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,604.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,563.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.41
|
| Rate for Payer: PHCS Commercial |
$3,932.40
|
| Rate for Payer: United Healthcare All Payer |
$3,604.70
|
|
|
JOURNEY PAT RESRF RD 26MM SM
|
Facility
|
OP
|
$4,096.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.88 |
| Max. Negotiated Rate |
$3,932.40 |
| Rate for Payer: Aetna Commercial |
$3,154.11
|
| Rate for Payer: Anthem Medicaid |
$1,408.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.07
|
| Rate for Payer: Cash Price |
$2,048.12
|
| Rate for Payer: Cigna Commercial |
$3,399.89
|
| Rate for Payer: First Health Commercial |
$3,891.44
|
| Rate for Payer: Humana Commercial |
$3,481.81
|
| Rate for Payer: Humana KY Medicaid |
$1,408.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,358.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,228.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,436.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,604.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,563.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.41
|
| Rate for Payer: PHCS Commercial |
$3,932.40
|
| Rate for Payer: United Healthcare All Payer |
$3,604.70
|
|
|
JOURNEY PAT RESRF RD 26MM STD
|
Facility
|
IP
|
$4,096.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.88 |
| Max. Negotiated Rate |
$3,932.40 |
| Rate for Payer: Aetna Commercial |
$3,154.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.07
|
| Rate for Payer: Cash Price |
$2,048.12
|
| Rate for Payer: Cigna Commercial |
$3,399.89
|
| Rate for Payer: First Health Commercial |
$3,891.44
|
| Rate for Payer: Humana Commercial |
$3,481.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,358.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,228.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,604.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,563.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.41
|
| Rate for Payer: PHCS Commercial |
$3,932.40
|
| Rate for Payer: United Healthcare All Payer |
$3,604.70
|
|
|
JOURNEY PAT RESRF RD 26MM STD
|
Facility
|
OP
|
$4,096.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.88 |
| Max. Negotiated Rate |
$3,932.40 |
| Rate for Payer: Aetna Commercial |
$3,154.11
|
| Rate for Payer: Anthem Medicaid |
$1,408.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.07
|
| Rate for Payer: Cash Price |
$2,048.12
|
| Rate for Payer: Cigna Commercial |
$3,399.89
|
| Rate for Payer: First Health Commercial |
$3,891.44
|
| Rate for Payer: Humana Commercial |
$3,481.81
|
| Rate for Payer: Humana KY Medicaid |
$1,408.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,358.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,228.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,436.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,604.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,563.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.41
|
| Rate for Payer: PHCS Commercial |
$3,932.40
|
| Rate for Payer: United Healthcare All Payer |
$3,604.70
|
|
|
JOURNEY PAT RESRF RD 29MM SM
|
Facility
|
OP
|
$4,096.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.88 |
| Max. Negotiated Rate |
$3,932.40 |
| Rate for Payer: Aetna Commercial |
$3,154.11
|
| Rate for Payer: Anthem Medicaid |
$1,408.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.07
|
| Rate for Payer: Cash Price |
$2,048.12
|
| Rate for Payer: Cigna Commercial |
$3,399.89
|
| Rate for Payer: First Health Commercial |
$3,891.44
|
| Rate for Payer: Humana Commercial |
$3,481.81
|
| Rate for Payer: Humana KY Medicaid |
$1,408.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,358.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,228.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,436.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,604.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,563.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.41
|
| Rate for Payer: PHCS Commercial |
$3,932.40
|
| Rate for Payer: United Healthcare All Payer |
$3,604.70
|
|
|
JOURNEY PAT RESRF RD 29MM SM
|
Facility
|
IP
|
$4,096.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.88 |
| Max. Negotiated Rate |
$3,932.40 |
| Rate for Payer: Aetna Commercial |
$3,154.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.07
|
| Rate for Payer: Cash Price |
$2,048.12
|
| Rate for Payer: Cigna Commercial |
$3,399.89
|
| Rate for Payer: First Health Commercial |
$3,891.44
|
| Rate for Payer: Humana Commercial |
$3,481.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,358.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,228.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,604.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,563.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.41
|
| Rate for Payer: PHCS Commercial |
$3,932.40
|
| Rate for Payer: United Healthcare All Payer |
$3,604.70
|
|
|
JOURNEY PAT RESRF RD 29MM STD
|
Facility
|
OP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem Medicaid |
$1,139.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Humana KY Medicaid |
$1,139.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
JOURNEY PAT RESRF RD 29MM STD
|
Facility
|
IP
|
$3,312.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$993.75 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$2,550.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,583.75
|
| Rate for Payer: Cash Price |
$1,656.25
|
| Rate for Payer: Cigna Commercial |
$2,749.38
|
| Rate for Payer: First Health Commercial |
$3,146.88
|
| Rate for Payer: Humana Commercial |
$2,815.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,444.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.62
|
| Rate for Payer: PHCS Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare All Payer |
$2,915.00
|
|
|
JOURNEY PAT RESRF RD 32MM SM
|
Facility
|
OP
|
$4,096.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.88 |
| Max. Negotiated Rate |
$3,932.40 |
| Rate for Payer: Aetna Commercial |
$3,154.11
|
| Rate for Payer: Anthem Medicaid |
$1,408.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.07
|
| Rate for Payer: Cash Price |
$2,048.12
|
| Rate for Payer: Cigna Commercial |
$3,399.89
|
| Rate for Payer: First Health Commercial |
$3,891.44
|
| Rate for Payer: Humana Commercial |
$3,481.81
|
| Rate for Payer: Humana KY Medicaid |
$1,408.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,358.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,228.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,436.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,604.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,563.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.41
|
| Rate for Payer: PHCS Commercial |
$3,932.40
|
| Rate for Payer: United Healthcare All Payer |
$3,604.70
|
|
|
JOURNEY PAT RESRF RD 32MM SM
|
Facility
|
IP
|
$4,096.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.88 |
| Max. Negotiated Rate |
$3,932.40 |
| Rate for Payer: Aetna Commercial |
$3,154.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.07
|
| Rate for Payer: Cash Price |
$2,048.12
|
| Rate for Payer: Cigna Commercial |
$3,399.89
|
| Rate for Payer: First Health Commercial |
$3,891.44
|
| Rate for Payer: Humana Commercial |
$3,481.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,358.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,228.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,604.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,563.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.41
|
| Rate for Payer: PHCS Commercial |
$3,932.40
|
| Rate for Payer: United Healthcare All Payer |
$3,604.70
|
|
|
JOURNEY PAT RESRF RD 32MM STD
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
JOURNEY PAT RESRF RD 32MM STD
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
JOURNEY PAT RESRF RD 35MM STD
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
JOURNEY PAT RESRF RD 35MM STD
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
JOURNEY PAT RESRF RD 38MM STD
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
JOURNEY PAT RESRF RD 38MM STD
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
JOURNEY PAT RESRF RD 41MM STD
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
JOURNEY PAT RESRF RD 41MM STD
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
JOURNEY POLY TIB 1LM/RL 10MM
|
Facility
|
OP
|
$9,546.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.88 |
| Max. Negotiated Rate |
$9,164.42 |
| Rate for Payer: Aetna Commercial |
$7,350.63
|
| Rate for Payer: Anthem Medicaid |
$3,282.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,446.09
|
| Rate for Payer: Cash Price |
$4,773.14
|
| Rate for Payer: Cigna Commercial |
$7,923.40
|
| Rate for Payer: First Health Commercial |
$9,068.96
|
| Rate for Payer: Humana Commercial |
$8,114.33
|
| Rate for Payer: Humana KY Medicaid |
$3,282.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,316.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,827.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,045.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,863.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,348.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,400.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,159.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,637.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,305.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,586.93
|
| Rate for Payer: PHCS Commercial |
$9,164.42
|
| Rate for Payer: United Healthcare All Payer |
$8,400.72
|
|
|
JOURNEY POLY TIB 1LM/RL 10MM
|
Facility
|
IP
|
$9,546.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.88 |
| Max. Negotiated Rate |
$9,164.42 |
| Rate for Payer: Aetna Commercial |
$7,350.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,446.09
|
| Rate for Payer: Cash Price |
$4,773.14
|
| Rate for Payer: Cigna Commercial |
$7,923.40
|
| Rate for Payer: First Health Commercial |
$9,068.96
|
| Rate for Payer: Humana Commercial |
$8,114.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,827.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,045.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,863.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,400.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,159.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,637.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,305.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,586.93
|
| Rate for Payer: PHCS Commercial |
$9,164.42
|
| Rate for Payer: United Healthcare All Payer |
$8,400.72
|
|
|
JOURNEY POLY TIB 1LM/RL 11MM
|
Facility
|
IP
|
$9,546.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.88 |
| Max. Negotiated Rate |
$9,164.42 |
| Rate for Payer: Aetna Commercial |
$7,350.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,446.09
|
| Rate for Payer: Cash Price |
$4,773.14
|
| Rate for Payer: Cigna Commercial |
$7,923.40
|
| Rate for Payer: First Health Commercial |
$9,068.96
|
| Rate for Payer: Humana Commercial |
$8,114.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,827.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,045.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,863.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,400.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,159.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,637.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,305.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,586.93
|
| Rate for Payer: PHCS Commercial |
$9,164.42
|
| Rate for Payer: United Healthcare All Payer |
$8,400.72
|
|
|
JOURNEY POLY TIB 1LM/RL 11MM
|
Facility
|
OP
|
$9,546.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.88 |
| Max. Negotiated Rate |
$9,164.42 |
| Rate for Payer: Aetna Commercial |
$7,350.63
|
| Rate for Payer: Anthem Medicaid |
$3,282.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,446.09
|
| Rate for Payer: Cash Price |
$4,773.14
|
| Rate for Payer: Cigna Commercial |
$7,923.40
|
| Rate for Payer: First Health Commercial |
$9,068.96
|
| Rate for Payer: Humana Commercial |
$8,114.33
|
| Rate for Payer: Humana KY Medicaid |
$3,282.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,316.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,827.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,045.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,863.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,348.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,400.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,159.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,637.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,305.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,586.93
|
| Rate for Payer: PHCS Commercial |
$9,164.42
|
| Rate for Payer: United Healthcare All Payer |
$8,400.72
|
|
|
JOURNEY POLY TIB 1LM/RL 8MM
|
Facility
|
IP
|
$9,546.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.88 |
| Max. Negotiated Rate |
$9,164.42 |
| Rate for Payer: Aetna Commercial |
$7,350.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,446.09
|
| Rate for Payer: Cash Price |
$4,773.14
|
| Rate for Payer: Cigna Commercial |
$7,923.40
|
| Rate for Payer: First Health Commercial |
$9,068.96
|
| Rate for Payer: Humana Commercial |
$8,114.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,827.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,045.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,863.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,400.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,159.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,637.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,305.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,586.93
|
| Rate for Payer: PHCS Commercial |
$9,164.42
|
| Rate for Payer: United Healthcare All Payer |
$8,400.72
|
|
|
JOURNEY POLY TIB 1LM/RL 8MM
|
Facility
|
OP
|
$9,546.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.88 |
| Max. Negotiated Rate |
$9,164.42 |
| Rate for Payer: Aetna Commercial |
$7,350.63
|
| Rate for Payer: Anthem Medicaid |
$3,282.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,446.09
|
| Rate for Payer: Cash Price |
$4,773.14
|
| Rate for Payer: Cigna Commercial |
$7,923.40
|
| Rate for Payer: First Health Commercial |
$9,068.96
|
| Rate for Payer: Humana Commercial |
$8,114.33
|
| Rate for Payer: Humana KY Medicaid |
$3,282.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,316.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,827.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,045.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,863.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,348.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,400.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,159.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,637.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,305.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,586.93
|
| Rate for Payer: PHCS Commercial |
$9,164.42
|
| Rate for Payer: United Healthcare All Payer |
$8,400.72
|
|
