|
VANDUAR PS OPEN POR FEM 57.5 L
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 57.5 R
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 57.5 R
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 62.5 L
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 62.5 L
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 62.5 R
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 62.5 R
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 67.5 L
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 67.5 L
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 67.5 R
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 67.5 R
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 72.5 L
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 72.5 L
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 72.5 R
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR PS OPEN POR FEM 72.5 R
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANDUAR SSK PSC INTLK FEM 55 L
|
Facility
|
IP
|
$39,248.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,102.33 |
| Max. Negotiated Rate |
$37,678.75 |
| Rate for Payer: Aetna Commercial |
$30,221.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,613.99
|
| Rate for Payer: Cash Price |
$19,624.35
|
| Rate for Payer: Cigna Commercial |
$32,576.42
|
| Rate for Payer: First Health Commercial |
$37,286.26
|
| Rate for Payer: Humana Commercial |
$33,361.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,183.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,965.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,774.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,538.86
|
| Rate for Payer: Ohio Health Group HMO |
$29,436.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,849.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,102.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,167.10
|
| Rate for Payer: PHCS Commercial |
$37,678.75
|
| Rate for Payer: United Healthcare All Payer |
$34,538.86
|
|
|
VANDUAR SSK PSC INTLK FEM 55 L
|
Facility
|
OP
|
$39,248.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,102.33 |
| Max. Negotiated Rate |
$37,678.75 |
| Rate for Payer: Aetna Commercial |
$30,221.50
|
| Rate for Payer: Anthem Medicaid |
$13,497.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,613.99
|
| Rate for Payer: Cash Price |
$19,624.35
|
| Rate for Payer: Cigna Commercial |
$32,576.42
|
| Rate for Payer: First Health Commercial |
$37,286.26
|
| Rate for Payer: Humana Commercial |
$33,361.40
|
| Rate for Payer: Humana KY Medicaid |
$13,497.63
|
| Rate for Payer: Kentucky WC Medicaid |
$13,635.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,183.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,965.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,774.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,768.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,538.86
|
| Rate for Payer: Ohio Health Group HMO |
$29,436.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,849.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,102.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,167.10
|
| Rate for Payer: PHCS Commercial |
$37,678.75
|
| Rate for Payer: United Healthcare All Payer |
$34,538.86
|
|
|
VANDUAR SSK PSC INTLK FEM 55 R
|
Facility
|
OP
|
$39,248.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,102.33 |
| Max. Negotiated Rate |
$37,678.75 |
| Rate for Payer: Aetna Commercial |
$30,221.50
|
| Rate for Payer: Anthem Medicaid |
$13,497.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,613.99
|
| Rate for Payer: Cash Price |
$19,624.35
|
| Rate for Payer: Cigna Commercial |
$32,576.42
|
| Rate for Payer: First Health Commercial |
$37,286.26
|
| Rate for Payer: Humana Commercial |
$33,361.40
|
| Rate for Payer: Humana KY Medicaid |
$13,497.63
|
| Rate for Payer: Kentucky WC Medicaid |
$13,635.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,183.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,965.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,774.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,768.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,538.86
|
| Rate for Payer: Ohio Health Group HMO |
$29,436.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,849.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,102.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,167.10
|
| Rate for Payer: PHCS Commercial |
$37,678.75
|
| Rate for Payer: United Healthcare All Payer |
$34,538.86
|
|
|
VANDUAR SSK PSC INTLK FEM 55 R
|
Facility
|
IP
|
$39,248.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,102.33 |
| Max. Negotiated Rate |
$37,678.75 |
| Rate for Payer: Aetna Commercial |
$30,221.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,613.99
|
| Rate for Payer: Cash Price |
$19,624.35
|
| Rate for Payer: Cigna Commercial |
$32,576.42
|
| Rate for Payer: First Health Commercial |
$37,286.26
|
| Rate for Payer: Humana Commercial |
$33,361.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,183.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,965.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,774.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,538.86
|
| Rate for Payer: Ohio Health Group HMO |
$29,436.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,849.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,102.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,167.10
|
| Rate for Payer: PHCS Commercial |
$37,678.75
|
| Rate for Payer: United Healthcare All Payer |
$34,538.86
|
|
|
VANDUAR SSK PSC INTLK FEM 60 L
|
Facility
|
OP
|
$39,248.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,102.33 |
| Max. Negotiated Rate |
$37,678.75 |
| Rate for Payer: Aetna Commercial |
$30,221.50
|
| Rate for Payer: Anthem Medicaid |
$13,497.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,613.99
|
| Rate for Payer: Cash Price |
$19,624.35
|
| Rate for Payer: Cigna Commercial |
$32,576.42
|
| Rate for Payer: First Health Commercial |
$37,286.26
|
| Rate for Payer: Humana Commercial |
$33,361.40
|
| Rate for Payer: Humana KY Medicaid |
$13,497.63
|
| Rate for Payer: Kentucky WC Medicaid |
$13,635.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,183.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,965.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,774.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,768.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,538.86
|
| Rate for Payer: Ohio Health Group HMO |
$29,436.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,849.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,102.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,167.10
|
| Rate for Payer: PHCS Commercial |
$37,678.75
|
| Rate for Payer: United Healthcare All Payer |
$34,538.86
|
|
|
VANDUAR SSK PSC INTLK FEM 60 L
|
Facility
|
IP
|
$39,248.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,102.33 |
| Max. Negotiated Rate |
$37,678.75 |
| Rate for Payer: Aetna Commercial |
$30,221.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,613.99
|
| Rate for Payer: Cash Price |
$19,624.35
|
| Rate for Payer: Cigna Commercial |
$32,576.42
|
| Rate for Payer: First Health Commercial |
$37,286.26
|
| Rate for Payer: Humana Commercial |
$33,361.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,183.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,965.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,774.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,538.86
|
| Rate for Payer: Ohio Health Group HMO |
$29,436.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,849.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,102.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,167.10
|
| Rate for Payer: PHCS Commercial |
$37,678.75
|
| Rate for Payer: United Healthcare All Payer |
$34,538.86
|
|
|
VANDUAR SSK PSC INTLK FEM 60 R
|
Facility
|
IP
|
$39,248.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,102.33 |
| Max. Negotiated Rate |
$37,678.75 |
| Rate for Payer: Aetna Commercial |
$30,221.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,613.99
|
| Rate for Payer: Cash Price |
$19,624.35
|
| Rate for Payer: Cigna Commercial |
$32,576.42
|
| Rate for Payer: First Health Commercial |
$37,286.26
|
| Rate for Payer: Humana Commercial |
$33,361.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,183.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,965.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,774.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,538.86
|
| Rate for Payer: Ohio Health Group HMO |
$29,436.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,849.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,102.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,167.10
|
| Rate for Payer: PHCS Commercial |
$37,678.75
|
| Rate for Payer: United Healthcare All Payer |
$34,538.86
|
|
|
VANDUAR SSK PSC INTLK FEM 60 R
|
Facility
|
OP
|
$39,248.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,102.33 |
| Max. Negotiated Rate |
$37,678.75 |
| Rate for Payer: Aetna Commercial |
$30,221.50
|
| Rate for Payer: Anthem Medicaid |
$13,497.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,613.99
|
| Rate for Payer: Cash Price |
$19,624.35
|
| Rate for Payer: Cigna Commercial |
$32,576.42
|
| Rate for Payer: First Health Commercial |
$37,286.26
|
| Rate for Payer: Humana Commercial |
$33,361.40
|
| Rate for Payer: Humana KY Medicaid |
$13,497.63
|
| Rate for Payer: Kentucky WC Medicaid |
$13,635.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,183.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,965.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,774.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,768.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,538.86
|
| Rate for Payer: Ohio Health Group HMO |
$29,436.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,849.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,102.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,167.10
|
| Rate for Payer: PHCS Commercial |
$37,678.75
|
| Rate for Payer: United Healthcare All Payer |
$34,538.86
|
|
|
VANDUAR SSK PSC INTLK FEM 65 L
|
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 SSK PSC INTLK FEM 65 L
|
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
|
|
