|
VANDUAR SSK PSC INTLK FEM 65 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 65 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 70 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 70 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 70 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 70 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 75 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 75 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 75 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 75 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 80 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 80 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 80 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 80 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 PS TIB BRG S 10X59
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDUAR SSK PS TIB BRG S 10X59
|
Facility
|
IP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDUAR SSK PS TIB BRG S 12X59
|
Facility
|
IP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDUAR SSK PS TIB BRG S 12X59
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDUAR SSK PS TIB BRG S 14X59
|
Facility
|
IP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDUAR SSK PS TIB BRG S 14X59
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDUAR SSK PS TIB BRG S 16X59
|
Facility
|
IP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDUAR SSK PS TIB BRG S 16X59
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDUAR SSK PS TIB BRG S 18X59
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDUAR SSK PS TIB BRG S 18X59
|
Facility
|
IP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
|
VANDUAR SSK PS TIB BRG S 20X59
|
Facility
|
OP
|
$15,514.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.83 |
| Max. Negotiated Rate |
$14,893.52 |
| Rate for Payer: Aetna Commercial |
$11,945.84
|
| Rate for Payer: Anthem Medicaid |
$5,335.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,100.98
|
| Rate for Payer: Cash Price |
$7,757.04
|
| Rate for Payer: Cigna Commercial |
$12,876.69
|
| Rate for Payer: First Health Commercial |
$14,738.38
|
| Rate for Payer: Humana Commercial |
$13,186.97
|
| Rate for Payer: Humana KY Medicaid |
$5,335.29
|
| Rate for Payer: Kentucky WC Medicaid |
$5,389.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,721.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,654.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,442.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,652.39
|
| Rate for Payer: Ohio Health Group HMO |
$11,635.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,102.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,016.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,809.36
|
| Rate for Payer: PHCS Commercial |
$14,893.52
|
| Rate for Payer: United Healthcare All Payer |
$13,652.39
|
|
