|
VANCOMYCIN TROUGH
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
30000052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$13.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.54
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$13.54
|
| Rate for Payer: Humana Medicare Advantage |
$13.54
|
| Rate for Payer: Kentucky WC Medicaid |
$13.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.45
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
VANCOMYCIN TROUGH
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
30000052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.58
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.45
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
VANCYMYCIN 500MG (5GM VIAL)
|
Facility
|
OP
|
$359.26
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$344.89 |
| Rate for Payer: Aetna Commercial |
$276.63
|
| Rate for Payer: Anthem Medicaid |
$123.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.22
|
| Rate for Payer: Cash Price |
$179.63
|
| Rate for Payer: Cigna Commercial |
$298.19
|
| Rate for Payer: First Health Commercial |
$341.30
|
| Rate for Payer: Humana Commercial |
$305.37
|
| Rate for Payer: Humana KY Medicaid |
$123.55
|
| Rate for Payer: Kentucky WC Medicaid |
$124.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.15
|
| Rate for Payer: Ohio Health Group HMO |
$269.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.37
|
| Rate for Payer: PHCS Commercial |
$344.89
|
| Rate for Payer: United Healthcare All Payer |
$316.15
|
|
|
VANCYMYCIN 500MG (5GM VIAL)
|
Facility
|
IP
|
$359.26
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$344.89 |
| Rate for Payer: Aetna Commercial |
$276.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.22
|
| Rate for Payer: Cash Price |
$179.63
|
| Rate for Payer: Cigna Commercial |
$298.19
|
| Rate for Payer: First Health Commercial |
$341.30
|
| Rate for Payer: Humana Commercial |
$305.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.15
|
| Rate for Payer: Ohio Health Group HMO |
$269.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.37
|
| Rate for Payer: PHCS Commercial |
$344.89
|
| Rate for Payer: United Healthcare All Payer |
$316.15
|
|
|
VANDR DST FEM AUG 57.5X10 LL/R
|
Facility
|
OP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem Medicaid |
$2,988.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Humana KY Medicaid |
$2,988.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,048.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDR DST FEM AUG 57.5X10 LL/R
|
Facility
|
IP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDR DST FEM AUG 57.5X10 RL/L
|
Facility
|
IP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDR DST FEM AUG 57.5X10 RL/L
|
Facility
|
OP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem Medicaid |
$2,988.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Humana KY Medicaid |
$2,988.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,048.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDR DST FEM AUG 57.5X15 RL/L
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
VANDR DST FEM AUG 57.5X15 RL/L
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
VANDR DST FEM AUG 57.5X5 RL/LM
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
VANDR DST FEM AUG 57.5X5 RL/LM
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
VANDR DST FEM AUG 62.5X10 LL/R
|
Facility
|
OP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem Medicaid |
$2,988.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Humana KY Medicaid |
$2,988.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,048.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDR DST FEM AUG 62.5X10 LL/R
|
Facility
|
IP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDR DST FEM AUG 62.5X10 RL/L
|
Facility
|
OP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem Medicaid |
$2,988.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Humana KY Medicaid |
$2,988.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,048.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDR DST FEM AUG 62.5X10 RL/L
|
Facility
|
IP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDR DST FEM AUG 62.5X5 RL/LM
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
VANDR DST FEM AUG 62.5X5 RL/LM
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
VANDR DST FEM AUG 67.5X10 LL/R
|
Facility
|
IP
|
$8,220.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.72 |
| Max. Negotiated Rate |
$7,892.07 |
| Rate for Payer: Aetna Commercial |
$6,330.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,412.31
|
| Rate for Payer: Cash Price |
$4,110.45
|
| Rate for Payer: Cigna Commercial |
$6,823.36
|
| Rate for Payer: First Health Commercial |
$7,809.86
|
| Rate for Payer: Humana Commercial |
$6,987.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,741.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,067.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,234.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.48
|
| Rate for Payer: PHCS Commercial |
$7,892.07
|
| Rate for Payer: United Healthcare All Payer |
$7,234.40
|
|
|
VANDR DST FEM AUG 67.5X10 LL/R
|
Facility
|
OP
|
$8,220.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.72 |
| Max. Negotiated Rate |
$7,892.07 |
| Rate for Payer: Aetna Commercial |
$6,330.10
|
| Rate for Payer: Anthem Medicaid |
$2,827.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,412.31
|
| Rate for Payer: Cash Price |
$4,110.45
|
| Rate for Payer: Cigna Commercial |
$6,823.36
|
| Rate for Payer: First Health Commercial |
$7,809.86
|
| Rate for Payer: Humana Commercial |
$6,987.77
|
| Rate for Payer: Humana KY Medicaid |
$2,827.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,855.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,741.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,067.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,883.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,234.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.48
|
| Rate for Payer: PHCS Commercial |
$7,892.07
|
| Rate for Payer: United Healthcare All Payer |
$7,234.40
|
|
|
VANDR DST FEM AUG 67.5X10 RL/L
|
Facility
|
IP
|
$8,220.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.72 |
| Max. Negotiated Rate |
$7,892.07 |
| Rate for Payer: Aetna Commercial |
$6,330.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,412.31
|
| Rate for Payer: Cash Price |
$4,110.45
|
| Rate for Payer: Cigna Commercial |
$6,823.36
|
| Rate for Payer: First Health Commercial |
$7,809.86
|
| Rate for Payer: Humana Commercial |
$6,987.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,741.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,067.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,234.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.48
|
| Rate for Payer: PHCS Commercial |
$7,892.07
|
| Rate for Payer: United Healthcare All Payer |
$7,234.40
|
|
|
VANDR DST FEM AUG 67.5X10 RL/L
|
Facility
|
OP
|
$8,220.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.72 |
| Max. Negotiated Rate |
$7,892.07 |
| Rate for Payer: Aetna Commercial |
$6,330.10
|
| Rate for Payer: Anthem Medicaid |
$2,827.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,412.31
|
| Rate for Payer: Cash Price |
$4,110.45
|
| Rate for Payer: Cigna Commercial |
$6,823.36
|
| Rate for Payer: First Health Commercial |
$7,809.86
|
| Rate for Payer: Humana Commercial |
$6,987.77
|
| Rate for Payer: Humana KY Medicaid |
$2,827.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,855.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,741.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,067.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,883.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,234.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.48
|
| Rate for Payer: PHCS Commercial |
$7,892.07
|
| Rate for Payer: United Healthcare All Payer |
$7,234.40
|
|
|
VANDR DST FEM AUG 67.5X5 RL/LM
|
Facility
|
OP
|
$8,123.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.08 |
| Max. Negotiated Rate |
$7,798.72 |
| Rate for Payer: Aetna Commercial |
$6,255.23
|
| Rate for Payer: Anthem Medicaid |
$2,793.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,336.46
|
| Rate for Payer: Cash Price |
$4,061.84
|
| Rate for Payer: Cigna Commercial |
$6,742.65
|
| Rate for Payer: First Health Commercial |
$7,717.49
|
| Rate for Payer: Humana Commercial |
$6,905.12
|
| Rate for Payer: Humana KY Medicaid |
$2,793.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,822.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,661.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,995.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,849.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,148.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,092.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.34
|
| Rate for Payer: PHCS Commercial |
$7,798.72
|
| Rate for Payer: United Healthcare All Payer |
$7,148.83
|
|
|
VANDR DST FEM AUG 67.5X5 RL/LM
|
Facility
|
IP
|
$8,123.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.08 |
| Max. Negotiated Rate |
$7,798.72 |
| Rate for Payer: Aetna Commercial |
$6,255.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,336.46
|
| Rate for Payer: Cash Price |
$4,061.84
|
| Rate for Payer: Cigna Commercial |
$6,742.65
|
| Rate for Payer: First Health Commercial |
$7,717.49
|
| Rate for Payer: Humana Commercial |
$6,905.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,661.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,995.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,437.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,148.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,092.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.34
|
| Rate for Payer: PHCS Commercial |
$7,798.72
|
| Rate for Payer: United Healthcare All Payer |
$7,148.83
|
|
|
VANDR PST FEM AUG 57.5X5 LL/RM
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
