|
VANDUAR E1 PS TIB BRG 71/75*10
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*10
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*11
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*11
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*12
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*12
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*13
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*13
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*14
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*14
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*16
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*16
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*18
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 71/75*18
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 79/83*10
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 79/83*10
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 79/83*11
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 79/83*11
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 79/83*12
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 79/83*12
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 79/83*13
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 79/83*13
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 79/83*14
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 79/83*14
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUAR E1 PS TIB BRG 79/83*16
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
