|
VANDUR DIS AUG TRL 80*15 LL/RM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
VANDUR DIS AUG TRL 80*15 RL/LM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
VANDUR DIS AUG TRL 80*15 RL/LM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
VANDUR DST FEM AUG 55X10 LL/RM
|
Facility
|
IP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 55X10 LL/RM
|
Facility
|
OP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem Medicaid |
$2,988.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Humana KY Medicaid |
$2,988.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,048.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 55X10 RL/LM
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
VANDUR DST FEM AUG 55X10 RL/LM
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
VANDUR DST FEM AUG 55X15 RL/LM
|
Facility
|
IP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
VANDUR DST FEM AUG 55X15 RL/LM
|
Facility
|
OP
|
$8,577.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.04 |
| Max. Negotiated Rate |
$8,234.13 |
| Rate for Payer: Aetna Commercial |
$6,604.46
|
| Rate for Payer: Anthem Medicaid |
$2,949.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,690.23
|
| Rate for Payer: Cash Price |
$4,288.61
|
| Rate for Payer: Cigna Commercial |
$7,119.09
|
| Rate for Payer: First Health Commercial |
$8,148.36
|
| Rate for Payer: Humana Commercial |
$7,290.64
|
| Rate for Payer: Humana KY Medicaid |
$2,949.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,033.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.94
|
| Rate for Payer: PHCS Commercial |
$8,234.13
|
| Rate for Payer: United Healthcare All Payer |
$7,547.95
|
|
|
VANDUR DST FEM AUG 60X10 LL/RM
|
Facility
|
IP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 60X10 LL/RM
|
Facility
|
OP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem Medicaid |
$2,988.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Humana KY Medicaid |
$2,988.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,048.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 65X10 LL/RM
|
Facility
|
OP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem Medicaid |
$2,988.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Humana KY Medicaid |
$2,988.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,048.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 65X10 LL/RM
|
Facility
|
IP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 65X10 RL/LM
|
Facility
|
OP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem Medicaid |
$2,988.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Humana KY Medicaid |
$2,988.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,048.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 65X10 RL/LM
|
Facility
|
IP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 70X10 LL/RM
|
Facility
|
IP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 70X10 LL/RM
|
Facility
|
OP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem Medicaid |
$2,988.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Humana KY Medicaid |
$2,988.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,048.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 70X10 RL/LM
|
Facility
|
IP
|
$8,220.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.72 |
| Max. Negotiated Rate |
$7,892.07 |
| Rate for Payer: Aetna Commercial |
$6,330.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,412.31
|
| Rate for Payer: Cash Price |
$4,110.45
|
| Rate for Payer: Cigna Commercial |
$6,823.36
|
| Rate for Payer: First Health Commercial |
$7,809.86
|
| Rate for Payer: Humana Commercial |
$6,987.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,741.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,067.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,234.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.48
|
| Rate for Payer: PHCS Commercial |
$7,892.07
|
| Rate for Payer: United Healthcare All Payer |
$7,234.40
|
|
|
VANDUR DST FEM AUG 70X10 RL/LM
|
Facility
|
OP
|
$8,220.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.72 |
| Max. Negotiated Rate |
$7,892.07 |
| Rate for Payer: Aetna Commercial |
$6,330.10
|
| Rate for Payer: Anthem Medicaid |
$2,827.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,412.31
|
| Rate for Payer: Cash Price |
$4,110.45
|
| Rate for Payer: Cigna Commercial |
$6,823.36
|
| Rate for Payer: First Health Commercial |
$7,809.86
|
| Rate for Payer: Humana Commercial |
$6,987.77
|
| Rate for Payer: Humana KY Medicaid |
$2,827.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,855.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,741.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,067.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,883.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,234.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.48
|
| Rate for Payer: PHCS Commercial |
$7,892.07
|
| Rate for Payer: United Healthcare All Payer |
$7,234.40
|
|
|
VANDUR DST FEM AUG 75X10 LL/RM
|
Facility
|
IP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 75X10 LL/RM
|
Facility
|
OP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem Medicaid |
$2,988.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Humana KY Medicaid |
$2,988.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,048.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 75X10 RL/LM
|
Facility
|
IP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 75X10 RL/LM
|
Facility
|
OP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem Medicaid |
$2,988.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Humana KY Medicaid |
$2,988.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,048.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 80X10 LL/RM
|
Facility
|
IP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
|
VANDUR DST FEM AUG 80X10 LL/RM
|
Facility
|
OP
|
$8,691.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.84 |
| Max. Negotiated Rate |
$8,343.46 |
| Rate for Payer: Aetna Commercial |
$6,692.15
|
| Rate for Payer: Anthem Medicaid |
$2,988.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,779.06
|
| Rate for Payer: Cash Price |
$4,345.55
|
| Rate for Payer: Cigna Commercial |
$7,213.61
|
| Rate for Payer: First Health Commercial |
$8,256.54
|
| Rate for Payer: Humana Commercial |
$7,387.44
|
| Rate for Payer: Humana KY Medicaid |
$2,988.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,019.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,414.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,607.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,048.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,648.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,518.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,694.24
|
| Rate for Payer: PHCS Commercial |
$8,343.46
|
| Rate for Payer: United Healthcare All Payer |
$7,648.17
|
|
