|
JOURNEY TIB SZ 2 LM/RL 7MM
|
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 TIB SZ 2 LM/RL 7MM
|
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 TIB SZ 2 RM/LL 7MM
|
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 TIB SZ 2 RM/LL 7MM
|
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 TIB SZ 3 LM/RL 7MM
|
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 TIB SZ 3 LM/RL 7MM
|
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 TIB SZ 3 RM/LL 7MM
|
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 TIB SZ 3 RM/LL 7MM
|
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 TIB SZ 4 LM/RL 7MM
|
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 TIB SZ 4 LM/RL 7MM
|
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 TIB SZ 4 RM/LL 7MM
|
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 TIB SZ 4 RM/LL 7MM
|
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 TIB SZ 5 LM/RL 7MM
|
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 TIB SZ 5 LM/RL 7MM
|
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 TIB SZ 5 RM/LL 7MM
|
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 TIB SZ 5 RM/LL 7MM
|
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 TIB SZ 6 LM/RL 7MM
|
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 TIB SZ 6 LM/RL 7MM
|
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 TIB SZ 6 RM/LL 7MM
|
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 TIB SZ 6 RM/LL 7MM
|
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
|
|
|
JOURNEYTM 7.5 RND RESUR PAT 35
|
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
|
|
|
JOURNEYTM 7.5 RND RESUR PAT 35
|
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 VISIONAIRE CUT BLCK L
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
JOURNEY VISIONAIRE CUT BLCK L
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
JOURNY ARTINS BCS SM 1-2 LT 10
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
