|
JOURNY TIB INSRT S5-6LM/RL 11M
|
Facility
|
IP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNY TIB INSRT S5-6LM/RL 11M
|
Facility
|
OP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem Medicaid |
$2,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Humana KY Medicaid |
$2,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNY TIB INSRT S5-6LM/RL 8MM
|
Facility
|
OP
|
$4,734.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.51 |
| Max. Negotiated Rate |
$4,545.31 |
| Rate for Payer: Aetna Commercial |
$3,645.72
|
| Rate for Payer: Anthem Medicaid |
$1,628.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,693.07
|
| Rate for Payer: Cash Price |
$2,367.35
|
| Rate for Payer: Cigna Commercial |
$3,929.80
|
| Rate for Payer: First Health Commercial |
$4,497.96
|
| Rate for Payer: Humana Commercial |
$4,024.50
|
| Rate for Payer: Humana KY Medicaid |
$1,628.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,644.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,882.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,494.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,660.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,166.54
|
| Rate for Payer: Ohio Health Group HMO |
$3,551.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.76
|
| Rate for Payer: PHCS Commercial |
$4,545.31
|
| Rate for Payer: United Healthcare All Payer |
$4,166.54
|
|
|
JOURNY TIB INSRT S5-6LM/RL 8MM
|
Facility
|
IP
|
$4,734.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.51 |
| Max. Negotiated Rate |
$4,545.31 |
| Rate for Payer: Aetna Commercial |
$3,645.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,693.07
|
| Rate for Payer: Cash Price |
$2,367.35
|
| Rate for Payer: Cigna Commercial |
$3,929.80
|
| Rate for Payer: First Health Commercial |
$4,497.96
|
| Rate for Payer: Humana Commercial |
$4,024.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,882.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,494.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,166.54
|
| Rate for Payer: Ohio Health Group HMO |
$3,551.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.76
|
| Rate for Payer: PHCS Commercial |
$4,545.31
|
| Rate for Payer: United Healthcare All Payer |
$4,166.54
|
|
|
JOURNY TIB INSRT S5-6LM/RL 9MM
|
Facility
|
IP
|
$4,734.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.51 |
| Max. Negotiated Rate |
$4,545.31 |
| Rate for Payer: Aetna Commercial |
$3,645.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,693.07
|
| Rate for Payer: Cash Price |
$2,367.35
|
| Rate for Payer: Cigna Commercial |
$3,929.80
|
| Rate for Payer: First Health Commercial |
$4,497.96
|
| Rate for Payer: Humana Commercial |
$4,024.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,882.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,494.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,166.54
|
| Rate for Payer: Ohio Health Group HMO |
$3,551.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.76
|
| Rate for Payer: PHCS Commercial |
$4,545.31
|
| Rate for Payer: United Healthcare All Payer |
$4,166.54
|
|
|
JOURNY TIB INSRT S5-6LM/RL 9MM
|
Facility
|
OP
|
$4,734.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.51 |
| Max. Negotiated Rate |
$4,545.31 |
| Rate for Payer: Aetna Commercial |
$3,645.72
|
| Rate for Payer: Anthem Medicaid |
$1,628.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,693.07
|
| Rate for Payer: Cash Price |
$2,367.35
|
| Rate for Payer: Cigna Commercial |
$3,929.80
|
| Rate for Payer: First Health Commercial |
$4,497.96
|
| Rate for Payer: Humana Commercial |
$4,024.50
|
| Rate for Payer: Humana KY Medicaid |
$1,628.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,644.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,882.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,494.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,660.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,166.54
|
| Rate for Payer: Ohio Health Group HMO |
$3,551.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.76
|
| Rate for Payer: PHCS Commercial |
$4,545.31
|
| Rate for Payer: United Healthcare All Payer |
$4,166.54
|
|
|
JOURNY TIB INSRT S5-6RM/LL 10M
|
Facility
|
IP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNY TIB INSRT S5-6RM/LL 10M
|
Facility
|
OP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem Medicaid |
$2,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Humana KY Medicaid |
$2,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNY TIB INSRT S5-6RM/LL 11M
|
Facility
|
OP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem Medicaid |
$2,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Humana KY Medicaid |
$2,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNY TIB INSRT S5-6RM/LL 11M
|
Facility
|
IP
|
$7,934.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.50 |
| Max. Negotiated Rate |
$7,617.25 |
| Rate for Payer: Aetna Commercial |
$6,109.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.02
|
| Rate for Payer: Cash Price |
$3,967.32
|
| Rate for Payer: Cigna Commercial |
$6,585.75
|
| Rate for Payer: First Health Commercial |
$7,537.91
|
| Rate for Payer: Humana Commercial |
$6,744.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,950.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,586.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.74
|
| Rate for Payer: PHCS Commercial |
$7,617.25
|
| Rate for Payer: United Healthcare All Payer |
$6,982.48
|
|
|
JOURNY TIB INSRT S5-6RM/LL 8MM
|
Facility
|
OP
|
$4,734.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.51 |
| Max. Negotiated Rate |
$4,545.31 |
| Rate for Payer: Aetna Commercial |
$3,645.72
|
| Rate for Payer: Anthem Medicaid |
$1,628.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,693.07
|
| Rate for Payer: Cash Price |
$2,367.35
|
| Rate for Payer: Cigna Commercial |
$3,929.80
|
| Rate for Payer: First Health Commercial |
$4,497.96
|
| Rate for Payer: Humana Commercial |
$4,024.50
|
| Rate for Payer: Humana KY Medicaid |
$1,628.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,644.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,882.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,494.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,660.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,166.54
|
| Rate for Payer: Ohio Health Group HMO |
$3,551.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.76
|
| Rate for Payer: PHCS Commercial |
$4,545.31
|
| Rate for Payer: United Healthcare All Payer |
$4,166.54
|
|
|
JOURNY TIB INSRT S5-6RM/LL 8MM
|
Facility
|
IP
|
$4,734.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.51 |
| Max. Negotiated Rate |
$4,545.31 |
| Rate for Payer: Aetna Commercial |
$3,645.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,693.07
|
| Rate for Payer: Cash Price |
$2,367.35
|
| Rate for Payer: Cigna Commercial |
$3,929.80
|
| Rate for Payer: First Health Commercial |
$4,497.96
|
| Rate for Payer: Humana Commercial |
$4,024.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,882.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,494.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,166.54
|
| Rate for Payer: Ohio Health Group HMO |
$3,551.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.76
|
| Rate for Payer: PHCS Commercial |
$4,545.31
|
| Rate for Payer: United Healthcare All Payer |
$4,166.54
|
|
|
JOURNY TIB INSRT S5-6RM/LL 9MM
|
Facility
|
OP
|
$4,734.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.51 |
| Max. Negotiated Rate |
$4,545.31 |
| Rate for Payer: Aetna Commercial |
$3,645.72
|
| Rate for Payer: Anthem Medicaid |
$1,628.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,693.07
|
| Rate for Payer: Cash Price |
$2,367.35
|
| Rate for Payer: Cigna Commercial |
$3,929.80
|
| Rate for Payer: First Health Commercial |
$4,497.96
|
| Rate for Payer: Humana Commercial |
$4,024.50
|
| Rate for Payer: Humana KY Medicaid |
$1,628.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,644.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,882.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,494.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,660.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,166.54
|
| Rate for Payer: Ohio Health Group HMO |
$3,551.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.76
|
| Rate for Payer: PHCS Commercial |
$4,545.31
|
| Rate for Payer: United Healthcare All Payer |
$4,166.54
|
|
|
JOURNY TIB INSRT S5-6RM/LL 9MM
|
Facility
|
IP
|
$4,734.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.51 |
| Max. Negotiated Rate |
$4,545.31 |
| Rate for Payer: Aetna Commercial |
$3,645.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,693.07
|
| Rate for Payer: Cash Price |
$2,367.35
|
| Rate for Payer: Cigna Commercial |
$3,929.80
|
| Rate for Payer: First Health Commercial |
$4,497.96
|
| Rate for Payer: Humana Commercial |
$4,024.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,882.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,494.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,166.54
|
| Rate for Payer: Ohio Health Group HMO |
$3,551.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.76
|
| Rate for Payer: PHCS Commercial |
$4,545.31
|
| Rate for Payer: United Healthcare All Payer |
$4,166.54
|
|
|
JOURNYTM 7.5 RND RESUR PT 26MM
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
JOURNYTM 7.5 RND RESUR PT 26MM
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
JOURNYTM 7.5 RND RESUR PT 29MM
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
JOURNYTM 7.5 RND RESUR PT 29MM
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
JOURNYTM 7.5 RND RESUR PT 32MM
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
JOURNYTM 7.5 RND RESUR PT 32MM
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
JOURNY VISIONAIRE CUT BLCK NSL
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
JOURNY VISIONAIRE CUT BLCK NSL
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
JOURNY VISIONAIRE CUT BLCK NSR
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
JOURNY VISIONAIRE CUT BLCK NSR
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
JOURNY VISIONAIR MRI TIB BLCKL
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
