|
JRNY II DD ISRT XLP SZ5-6*11R
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5-6*11R
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5/6*12L
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5/6*12L
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5-6*12R
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5-6*12R
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5/6*13L
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5/6*13L
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5-6*13R
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5-6*13R
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5/6*15L
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5/6*15L
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5-6*15R
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5-6*15R
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5/6*18L
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5/6*18L
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5-6*18R
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5-6*18R
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5/6*9L
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5/6*9L
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5-6*9R
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ5-6*9R
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ7-8*10L
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ7-8*10L
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
JRNY II DD ISRT XLP SZ7-8*10R
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
