|
JOURNY ARTINS BCS STD 7-8 R 10
|
Facility
|
IP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 R 10
|
Facility
|
OP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem Medicaid |
$2,938.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Humana KY Medicaid |
$2,938.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 R 11
|
Facility
|
OP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem Medicaid |
$2,938.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Humana KY Medicaid |
$2,938.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 R 11
|
Facility
|
IP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 R 13
|
Facility
|
OP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem Medicaid |
$2,938.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Humana KY Medicaid |
$2,938.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 R 13
|
Facility
|
IP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 R 15
|
Facility
|
OP
|
$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 Medicaid |
$2,286.93
|
| 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: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| 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: Molina Healthcare Medicaid |
$2,332.82
|
| 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
|
|
|
JOURNY ARTINS BCS STD 7-8 R 15
|
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
|
|
|
JOURNY ARTINS BCS STD 7-8 R 18
|
Facility
|
IP
|
$6,796.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.80 |
| Max. Negotiated Rate |
$6,524.16 |
| Rate for Payer: Aetna Commercial |
$5,232.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.88
|
| Rate for Payer: Cash Price |
$3,398.00
|
| Rate for Payer: Cigna Commercial |
$5,640.68
|
| Rate for Payer: First Health Commercial |
$6,456.20
|
| Rate for Payer: Humana Commercial |
$5,776.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,572.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,015.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,980.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,097.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,912.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,689.24
|
| Rate for Payer: PHCS Commercial |
$6,524.16
|
| Rate for Payer: United Healthcare All Payer |
$5,980.48
|
|
|
JOURNY ARTINS BCS STD 7-8 R 18
|
Facility
|
OP
|
$6,796.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,038.80 |
| Max. Negotiated Rate |
$6,524.16 |
| Rate for Payer: Aetna Commercial |
$5,232.92
|
| Rate for Payer: Anthem Medicaid |
$2,337.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,300.88
|
| Rate for Payer: Cash Price |
$3,398.00
|
| Rate for Payer: Cigna Commercial |
$5,640.68
|
| Rate for Payer: First Health Commercial |
$6,456.20
|
| Rate for Payer: Humana Commercial |
$5,776.60
|
| Rate for Payer: Humana KY Medicaid |
$2,337.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,360.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,572.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,015.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,038.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,384.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,980.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,097.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,912.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,689.24
|
| Rate for Payer: PHCS Commercial |
$6,524.16
|
| Rate for Payer: United Healthcare All Payer |
$5,980.48
|
|
|
JOURNY ARTINS BCS STD 7-8 R 21
|
Facility
|
OP
|
$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 Medicaid |
$2,286.93
|
| 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: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| 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: Molina Healthcare Medicaid |
$2,332.82
|
| 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
|
|
|
JOURNY ARTINS BCS STD 7-8 R 21
|
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
|
|
|
JOURNY ARTINS BCS STD 7-8 R 25
|
Facility
|
IP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ARTINS BCS STD 7-8 R 25
|
Facility
|
OP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem Medicaid |
$2,938.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Humana KY Medicaid |
$2,938.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ART INS BCS STD 7-8 R 9
|
Facility
|
IP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY ART INS BCS STD 7-8 R 9
|
Facility
|
OP
|
$8,544.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,563.25 |
| Max. Negotiated Rate |
$8,202.40 |
| Rate for Payer: Aetna Commercial |
$6,579.01
|
| Rate for Payer: Anthem Medicaid |
$2,938.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,664.45
|
| Rate for Payer: Cash Price |
$4,272.08
|
| Rate for Payer: Cigna Commercial |
$7,091.66
|
| Rate for Payer: First Health Commercial |
$8,116.96
|
| Rate for Payer: Humana Commercial |
$7,262.54
|
| Rate for Payer: Humana KY Medicaid |
$2,938.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,305.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,518.87
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,835.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,433.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,895.48
|
| Rate for Payer: PHCS Commercial |
$8,202.40
|
| Rate for Payer: United Healthcare All Payer |
$7,518.87
|
|
|
JOURNY TIB INSRT S1-2LM/RL 10M
|
Facility
|
OP
|
$8,134.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,440.39 |
| Max. Negotiated Rate |
$7,809.25 |
| Rate for Payer: Aetna Commercial |
$6,263.67
|
| Rate for Payer: Anthem Medicaid |
$2,797.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,345.02
|
| Rate for Payer: Cash Price |
$4,067.32
|
| Rate for Payer: Cigna Commercial |
$6,751.75
|
| Rate for Payer: First Health Commercial |
$7,727.91
|
| Rate for Payer: Humana Commercial |
$6,914.44
|
| Rate for Payer: Humana KY Medicaid |
$2,797.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,825.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,670.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,003.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,440.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,853.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,158.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,100.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,507.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,077.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,612.90
|
| Rate for Payer: PHCS Commercial |
$7,809.25
|
| Rate for Payer: United Healthcare All Payer |
$7,158.48
|
|
|
JOURNY TIB INSRT S1-2LM/RL 10M
|
Facility
|
IP
|
$8,134.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,440.39 |
| Max. Negotiated Rate |
$7,809.25 |
| Rate for Payer: Aetna Commercial |
$6,263.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,345.02
|
| Rate for Payer: Cash Price |
$4,067.32
|
| Rate for Payer: Cigna Commercial |
$6,751.75
|
| Rate for Payer: First Health Commercial |
$7,727.91
|
| Rate for Payer: Humana Commercial |
$6,914.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,670.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,003.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,440.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,158.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,100.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,507.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,077.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,612.90
|
| Rate for Payer: PHCS Commercial |
$7,809.25
|
| Rate for Payer: United Healthcare All Payer |
$7,158.48
|
|
|
JOURNY TIB INSRT S1-2LM/RL 11M
|
Facility
|
IP
|
$8,134.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,440.39 |
| Max. Negotiated Rate |
$7,809.25 |
| Rate for Payer: Aetna Commercial |
$6,263.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,345.02
|
| Rate for Payer: Cash Price |
$4,067.32
|
| Rate for Payer: Cigna Commercial |
$6,751.75
|
| Rate for Payer: First Health Commercial |
$7,727.91
|
| Rate for Payer: Humana Commercial |
$6,914.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,670.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,003.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,440.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,158.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,100.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,507.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,077.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,612.90
|
| Rate for Payer: PHCS Commercial |
$7,809.25
|
| Rate for Payer: United Healthcare All Payer |
$7,158.48
|
|
|
JOURNY TIB INSRT S1-2LM/RL 11M
|
Facility
|
OP
|
$8,134.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,440.39 |
| Max. Negotiated Rate |
$7,809.25 |
| Rate for Payer: Aetna Commercial |
$6,263.67
|
| Rate for Payer: Anthem Medicaid |
$2,797.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,345.02
|
| Rate for Payer: Cash Price |
$4,067.32
|
| Rate for Payer: Cigna Commercial |
$6,751.75
|
| Rate for Payer: First Health Commercial |
$7,727.91
|
| Rate for Payer: Humana Commercial |
$6,914.44
|
| Rate for Payer: Humana KY Medicaid |
$2,797.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,825.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,670.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,003.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,440.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,853.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,158.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,100.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,507.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,077.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,612.90
|
| Rate for Payer: PHCS Commercial |
$7,809.25
|
| Rate for Payer: United Healthcare All Payer |
$7,158.48
|
|
|
JOURNY TIB INSRT S1-2LM/RL 8MM
|
Facility
|
IP
|
$8,134.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,440.39 |
| Max. Negotiated Rate |
$7,809.25 |
| Rate for Payer: Aetna Commercial |
$6,263.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,345.02
|
| Rate for Payer: Cash Price |
$4,067.32
|
| Rate for Payer: Cigna Commercial |
$6,751.75
|
| Rate for Payer: First Health Commercial |
$7,727.91
|
| Rate for Payer: Humana Commercial |
$6,914.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,670.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,003.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,440.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,158.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,100.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,507.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,077.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,612.90
|
| Rate for Payer: PHCS Commercial |
$7,809.25
|
| Rate for Payer: United Healthcare All Payer |
$7,158.48
|
|
|
JOURNY TIB INSRT S1-2LM/RL 8MM
|
Facility
|
OP
|
$8,134.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,440.39 |
| Max. Negotiated Rate |
$7,809.25 |
| Rate for Payer: Aetna Commercial |
$6,263.67
|
| Rate for Payer: Anthem Medicaid |
$2,797.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,345.02
|
| Rate for Payer: Cash Price |
$4,067.32
|
| Rate for Payer: Cigna Commercial |
$6,751.75
|
| Rate for Payer: First Health Commercial |
$7,727.91
|
| Rate for Payer: Humana Commercial |
$6,914.44
|
| Rate for Payer: Humana KY Medicaid |
$2,797.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,825.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,670.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,003.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,440.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,853.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,158.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,100.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,507.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,077.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,612.90
|
| Rate for Payer: PHCS Commercial |
$7,809.25
|
| Rate for Payer: United Healthcare All Payer |
$7,158.48
|
|
|
JOURNY TIB INSRT S1-2LM/RL 9MM
|
Facility
|
IP
|
$8,134.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,440.39 |
| Max. Negotiated Rate |
$7,809.25 |
| Rate for Payer: Aetna Commercial |
$6,263.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,345.02
|
| Rate for Payer: Cash Price |
$4,067.32
|
| Rate for Payer: Cigna Commercial |
$6,751.75
|
| Rate for Payer: First Health Commercial |
$7,727.91
|
| Rate for Payer: Humana Commercial |
$6,914.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,670.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,003.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,440.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,158.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,100.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,507.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,077.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,612.90
|
| Rate for Payer: PHCS Commercial |
$7,809.25
|
| Rate for Payer: United Healthcare All Payer |
$7,158.48
|
|
|
JOURNY TIB INSRT S1-2LM/RL 9MM
|
Facility
|
OP
|
$8,134.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,440.39 |
| Max. Negotiated Rate |
$7,809.25 |
| Rate for Payer: Aetna Commercial |
$6,263.67
|
| Rate for Payer: Anthem Medicaid |
$2,797.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,345.02
|
| Rate for Payer: Cash Price |
$4,067.32
|
| Rate for Payer: Cigna Commercial |
$6,751.75
|
| Rate for Payer: First Health Commercial |
$7,727.91
|
| Rate for Payer: Humana Commercial |
$6,914.44
|
| Rate for Payer: Humana KY Medicaid |
$2,797.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,825.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,670.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,003.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,440.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,853.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,158.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,100.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,507.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,077.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,612.90
|
| Rate for Payer: PHCS Commercial |
$7,809.25
|
| Rate for Payer: United Healthcare All Payer |
$7,158.48
|
|
|
JOURNY TIB INSRT S1-2RM/LL 10M
|
Facility
|
IP
|
$8,134.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,440.39 |
| Max. Negotiated Rate |
$7,809.25 |
| Rate for Payer: Aetna Commercial |
$6,263.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,345.02
|
| Rate for Payer: Cash Price |
$4,067.32
|
| Rate for Payer: Cigna Commercial |
$6,751.75
|
| Rate for Payer: First Health Commercial |
$7,727.91
|
| Rate for Payer: Humana Commercial |
$6,914.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,670.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,003.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,440.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,158.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,100.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,507.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,077.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,612.90
|
| Rate for Payer: PHCS Commercial |
$7,809.25
|
| Rate for Payer: United Healthcare All Payer |
$7,158.48
|
|
