|
VANDUR DST FEM AUG 80X10 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 80X10 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 E1 CRL TIB BRG 79/83*16
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 79/83*16
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 79/83*18
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 79/83*18
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*10
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*10
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*11
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*11
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*12
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*12
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*13
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*13
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*14
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*14
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*16
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*16
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*18
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*18
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 PS+ TIB BRG 63/67*10
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 PS+ TIB BRG 63/67*10
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 PS+ TIB BRG 63/67*12
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 PS+ TIB BRG 63/67*12
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
VANDUR E1 PS+ TIB BRG 63/67*14
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
