|
VANDR SSK PS TIBBRG S 18X63/67
|
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 18X71/75
|
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 18X71/75
|
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 20X63/67
|
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 20X63/67
|
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 20X71/75
|
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 20X71/75
|
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 22X63/67
|
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 22X63/67
|
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 22X71/75
|
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 22X71/75
|
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 24X63/67
|
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 24X63/67
|
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 24X71/75
|
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 24X71/75
|
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 VNGD CR TIB BRG 63/67X10
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANDR VNGD CR TIB BRG 63/67X10
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANDR VNGD CR TIB BRG 63/67X11
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANDR VNGD CR TIB BRG 63/67X11
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANDR VNGD CR TIB BRG 63/67X12
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANDR VNGD CR TIB BRG 63/67X12
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANDR VNGD CR TIB BRG 63/67X13
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANDR VNGD CR TIB BRG 63/67X13
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANDR VNGD CR TIB BRG 63/67X14
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANDR VNGD CR TIB BRG 63/67X14
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
