VANDUAR DST AUG TRL 55*5 RL/LM
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 55*5 RL/LM
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem Medicaid |
$7.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Humana KY Medicaid |
$7.91
|
Rate for Payer: Kentucky WC Medicaid |
$7.99
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 60*5 LL/RM
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 60*5 LL/RM
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem Medicaid |
$7.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Humana KY Medicaid |
$7.91
|
Rate for Payer: Kentucky WC Medicaid |
$7.99
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 60*5 RL/LM
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 60*5 RL/LM
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem Medicaid |
$7.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Humana KY Medicaid |
$7.91
|
Rate for Payer: Kentucky WC Medicaid |
$7.99
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 65*5 LL/RM
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem Medicaid |
$7.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Humana KY Medicaid |
$7.91
|
Rate for Payer: Kentucky WC Medicaid |
$7.99
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 65*5 LL/RM
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 65*5 RL/LM
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem Medicaid |
$7.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Humana KY Medicaid |
$7.91
|
Rate for Payer: Kentucky WC Medicaid |
$7.99
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 65*5 RL/LM
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 70*5 LL/RM
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem Medicaid |
$7.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Humana KY Medicaid |
$7.91
|
Rate for Payer: Kentucky WC Medicaid |
$7.99
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 70*5 LL/RM
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 70*5 RL/LM
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 70*5 RL/LM
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem Medicaid |
$7.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Humana KY Medicaid |
$7.91
|
Rate for Payer: Kentucky WC Medicaid |
$7.99
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 75*5 LL/RM
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 75*5 LL/RM
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem Medicaid |
$7.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Humana KY Medicaid |
$7.91
|
Rate for Payer: Kentucky WC Medicaid |
$7.99
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 75*5 RL/LM
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 75*5 RL/LM
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem Medicaid |
$7.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Humana KY Medicaid |
$7.91
|
Rate for Payer: Kentucky WC Medicaid |
$7.99
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 80*5 LL/RM
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem Medicaid |
$7.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Humana KY Medicaid |
$7.91
|
Rate for Payer: Kentucky WC Medicaid |
$7.99
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 80*5 LL/RM
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 80*5 RL/LM
|
Facility
|
IP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST AUG TRL 80*5 RL/LM
|
Facility
|
OP
|
$23.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2.99 |
Max. Negotiated Rate |
$22.08 |
Rate for Payer: Aetna Commercial |
$17.71
|
Rate for Payer: Anthem Medicaid |
$7.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
Rate for Payer: Cash Price |
$11.50
|
Rate for Payer: Cigna Commercial |
$19.09
|
Rate for Payer: First Health Commercial |
$21.85
|
Rate for Payer: Humana Commercial |
$19.55
|
Rate for Payer: Humana KY Medicaid |
$7.91
|
Rate for Payer: Kentucky WC Medicaid |
$7.99
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
Rate for Payer: Ohio Health Group HMO |
$17.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
Rate for Payer: PHCS Commercial |
$22.08
|
Rate for Payer: United Healthcare All Payer |
$20.24
|
|
VANDUAR DST FEM AUG 55X5 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
|
|
VANDUAR DST FEM AUG 55X5 LL/RM
|
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
|
|
VANDUAR DST FEM AUG 55X5 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
|
|