|
VANDR SSK PSC TIB BRG 22X87/91
|
Facility
|
OP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem Medicaid |
$5,268.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Humana KY Medicaid |
$5,268.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,322.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,374.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDR SSK PSC TIB BRG 22X87/91
|
Facility
|
IP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDR SSK PSC TIB BRG 24X63/67
|
Facility
|
OP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem Medicaid |
$5,268.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Humana KY Medicaid |
$5,268.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,322.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,374.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDR SSK PSC TIB BRG 24X63/67
|
Facility
|
IP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDR SSK PSC TIB BRG 24X71/75
|
Facility
|
IP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDR SSK PSC TIB BRG 24X71/75
|
Facility
|
OP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem Medicaid |
$5,268.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Humana KY Medicaid |
$5,268.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,322.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,374.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDR SSK PSC TIB BRG 24X79/83
|
Facility
|
IP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDR SSK PSC TIB BRG 24X79/83
|
Facility
|
OP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem Medicaid |
$5,268.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Humana KY Medicaid |
$5,268.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,322.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,374.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDR SSK PSC TIB BRG 24X87/91
|
Facility
|
OP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem Medicaid |
$5,268.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Humana KY Medicaid |
$5,268.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,322.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,374.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDR SSK PSC TIB BRG 24X87/91
|
Facility
|
IP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDR SSK PS TIBBRG S 10X63/67
|
Facility
|
IP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 10X63/67
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 10X71/75
|
Facility
|
IP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 10X71/75
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 12X63/67
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 12X63/67
|
Facility
|
IP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 14X63/67
|
Facility
|
IP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 14X63/67
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 14X71/75
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 14X71/75
|
Facility
|
IP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 16X63/67
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 16X63/67
|
Facility
|
IP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 16X71/75
|
Facility
|
IP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 16X71/75
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDR SSK PS TIBBRG S 18X63/67
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
