|
VANDUR PST AUG TRL 60*10 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 PST AUG TRL 65*10 LL/RM
|
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 PST AUG TRL 65*10 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 PST AUG TRL 65*10 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 PST AUG TRL 65*10 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 PST AUG TRL 70*10 LL/RM
|
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 PST AUG TRL 70*10 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 PST AUG TRL 70*10 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 PST AUG TRL 70*10 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 PST AUG TRL 75*10 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 PST AUG TRL 75*10 LL/RM
|
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 PST AUG TRL 75*10 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 PST AUG TRL 75*10 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 PST AUG TRL 80*10 LL/RM
|
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 PST AUG TRL 80*10 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 PST AUG TRL 80*10 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 PST AUG TRL 80*10 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 SSK PS TIB BRG 10*87/91
|
Facility
|
IP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDUR SSK PS TIB BRG 10*87/91
|
Facility
|
OP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem Medicaid |
$5,268.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Humana KY Medicaid |
$5,268.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,322.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,374.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDUR SSK PS TIB BRG 10X63/67
|
Facility
|
OP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem Medicaid |
$5,268.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Humana KY Medicaid |
$5,268.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,322.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,374.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDUR SSK PS TIB BRG 10X63/67
|
Facility
|
IP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDUR SSK PS TIB BRG 10X71/75
|
Facility
|
OP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem Medicaid |
$5,268.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Humana KY Medicaid |
$5,268.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,322.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,374.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDUR SSK PS TIB BRG 10X71/75
|
Facility
|
IP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDUR SSK PS TIB BRG 10X79/83
|
Facility
|
OP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem Medicaid |
$5,268.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Humana KY Medicaid |
$5,268.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,322.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,374.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
|
VANDUR SSK PS TIB BRG 10X79/83
|
Facility
|
IP
|
$15,319.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,991.56 |
| Max. Negotiated Rate |
$14,706.89 |
| Rate for Payer: Aetna Commercial |
$11,796.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,949.35
|
| Rate for Payer: Cash Price |
$7,659.84
|
| Rate for Payer: Cigna Commercial |
$12,715.33
|
| Rate for Payer: First Health Commercial |
$14,553.70
|
| Rate for Payer: Humana Commercial |
$13,021.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,562.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,305.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,595.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,481.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,489.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,991.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.10
|
| Rate for Payer: PHCS Commercial |
$14,706.89
|
| Rate for Payer: United Healthcare All Payer |
$13,481.32
|
|
