|
JOURNY TIB INSRT S5-6LM/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 S5-6LM/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 S5-6LM/RL 8MM
|
Facility
|
OP
|
$4,715.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.72 |
| Max. Negotiated Rate |
$4,527.12 |
| Rate for Payer: Aetna Commercial |
$3,631.13
|
| Rate for Payer: Anthem Medicaid |
$1,621.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,678.28
|
| Rate for Payer: Cash Price |
$2,357.88
|
| Rate for Payer: Cigna Commercial |
$3,914.07
|
| Rate for Payer: First Health Commercial |
$4,479.96
|
| Rate for Payer: Humana Commercial |
$4,008.39
|
| Rate for Payer: Humana KY Medicaid |
$1,621.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,638.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,866.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,480.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,654.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,149.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,536.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,253.87
|
| Rate for Payer: PHCS Commercial |
$4,527.12
|
| Rate for Payer: United Healthcare All Payer |
$4,149.86
|
|
|
JOURNY TIB INSRT S5-6LM/RL 8MM
|
Facility
|
IP
|
$4,715.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.72 |
| Max. Negotiated Rate |
$4,527.12 |
| Rate for Payer: Aetna Commercial |
$3,631.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,678.28
|
| Rate for Payer: Cash Price |
$2,357.88
|
| Rate for Payer: Cigna Commercial |
$3,914.07
|
| Rate for Payer: First Health Commercial |
$4,479.96
|
| Rate for Payer: Humana Commercial |
$4,008.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,866.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,480.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,149.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,536.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,253.87
|
| Rate for Payer: PHCS Commercial |
$4,527.12
|
| Rate for Payer: United Healthcare All Payer |
$4,149.86
|
|
|
JOURNY TIB INSRT S5-6LM/RL 9MM
|
Facility
|
OP
|
$4,715.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.72 |
| Max. Negotiated Rate |
$4,527.12 |
| Rate for Payer: Aetna Commercial |
$3,631.13
|
| Rate for Payer: Anthem Medicaid |
$1,621.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,678.28
|
| Rate for Payer: Cash Price |
$2,357.88
|
| Rate for Payer: Cigna Commercial |
$3,914.07
|
| Rate for Payer: First Health Commercial |
$4,479.96
|
| Rate for Payer: Humana Commercial |
$4,008.39
|
| Rate for Payer: Humana KY Medicaid |
$1,621.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,638.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,866.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,480.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,654.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,149.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,536.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,253.87
|
| Rate for Payer: PHCS Commercial |
$4,527.12
|
| Rate for Payer: United Healthcare All Payer |
$4,149.86
|
|
|
JOURNY TIB INSRT S5-6LM/RL 9MM
|
Facility
|
IP
|
$4,715.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.72 |
| Max. Negotiated Rate |
$4,527.12 |
| Rate for Payer: Aetna Commercial |
$3,631.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,678.28
|
| Rate for Payer: Cash Price |
$2,357.88
|
| Rate for Payer: Cigna Commercial |
$3,914.07
|
| Rate for Payer: First Health Commercial |
$4,479.96
|
| Rate for Payer: Humana Commercial |
$4,008.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,866.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,480.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,149.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,536.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,253.87
|
| Rate for Payer: PHCS Commercial |
$4,527.12
|
| Rate for Payer: United Healthcare All Payer |
$4,149.86
|
|
|
JOURNY TIB INSRT S5-6RM/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
|
|
|
JOURNY TIB INSRT S5-6RM/LL 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 S5-6RM/LL 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 S5-6RM/LL 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 S5-6RM/LL 8MM
|
Facility
|
OP
|
$4,715.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.72 |
| Max. Negotiated Rate |
$4,527.12 |
| Rate for Payer: Aetna Commercial |
$3,631.13
|
| Rate for Payer: Anthem Medicaid |
$1,621.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,678.28
|
| Rate for Payer: Cash Price |
$2,357.88
|
| Rate for Payer: Cigna Commercial |
$3,914.07
|
| Rate for Payer: First Health Commercial |
$4,479.96
|
| Rate for Payer: Humana Commercial |
$4,008.39
|
| Rate for Payer: Humana KY Medicaid |
$1,621.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,638.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,866.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,480.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,654.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,149.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,536.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,253.87
|
| Rate for Payer: PHCS Commercial |
$4,527.12
|
| Rate for Payer: United Healthcare All Payer |
$4,149.86
|
|
|
JOURNY TIB INSRT S5-6RM/LL 8MM
|
Facility
|
IP
|
$4,715.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.72 |
| Max. Negotiated Rate |
$4,527.12 |
| Rate for Payer: Aetna Commercial |
$3,631.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,678.28
|
| Rate for Payer: Cash Price |
$2,357.88
|
| Rate for Payer: Cigna Commercial |
$3,914.07
|
| Rate for Payer: First Health Commercial |
$4,479.96
|
| Rate for Payer: Humana Commercial |
$4,008.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,866.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,480.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,149.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,536.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,253.87
|
| Rate for Payer: PHCS Commercial |
$4,527.12
|
| Rate for Payer: United Healthcare All Payer |
$4,149.86
|
|
|
JOURNY TIB INSRT S5-6RM/LL 9MM
|
Facility
|
OP
|
$4,715.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.72 |
| Max. Negotiated Rate |
$4,527.12 |
| Rate for Payer: Aetna Commercial |
$3,631.13
|
| Rate for Payer: Anthem Medicaid |
$1,621.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,678.28
|
| Rate for Payer: Cash Price |
$2,357.88
|
| Rate for Payer: Cigna Commercial |
$3,914.07
|
| Rate for Payer: First Health Commercial |
$4,479.96
|
| Rate for Payer: Humana Commercial |
$4,008.39
|
| Rate for Payer: Humana KY Medicaid |
$1,621.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,638.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,866.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,480.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,654.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,149.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,536.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,253.87
|
| Rate for Payer: PHCS Commercial |
$4,527.12
|
| Rate for Payer: United Healthcare All Payer |
$4,149.86
|
|
|
JOURNY TIB INSRT S5-6RM/LL 9MM
|
Facility
|
IP
|
$4,715.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.72 |
| Max. Negotiated Rate |
$4,527.12 |
| Rate for Payer: Aetna Commercial |
$3,631.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,678.28
|
| Rate for Payer: Cash Price |
$2,357.88
|
| Rate for Payer: Cigna Commercial |
$3,914.07
|
| Rate for Payer: First Health Commercial |
$4,479.96
|
| Rate for Payer: Humana Commercial |
$4,008.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,866.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,480.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,149.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,536.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,253.87
|
| Rate for Payer: PHCS Commercial |
$4,527.12
|
| Rate for Payer: United Healthcare All Payer |
$4,149.86
|
|
|
JOURNYTM 7.5 RND RESUR PT 26MM
|
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
|
|
|
JOURNYTM 7.5 RND RESUR PT 26MM
|
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
|
|
|
JOURNYTM 7.5 RND RESUR PT 29MM
|
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
|
|
|
JOURNYTM 7.5 RND RESUR PT 29MM
|
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
|
|
|
JOURNYTM 7.5 RND RESUR PT 32MM
|
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
|
|
|
JOURNYTM 7.5 RND RESUR PT 32MM
|
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
|
|
|
JOURNY VISIONAIRE CUT BLCK NSL
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
JOURNY VISIONAIRE CUT BLCK NSL
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
JOURNY VISIONAIRE CUT BLCK NSR
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
JOURNY VISIONAIRE CUT BLCK NSR
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
JOURNY VISIONAIR MRI TIB BLCKL
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
