|
VANDR DST FEM AUG 57.5X5 RL/LM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR DST FEM AUG 57.5X5 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR DST FEM AUG 62.5X10 LL/R
|
Facility
|
IP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDR DST FEM AUG 62.5X10 LL/R
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDR DST FEM AUG 62.5X10 RL/L
|
Facility
|
IP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDR DST FEM AUG 62.5X10 RL/L
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDR DST FEM AUG 62.5X5 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR DST FEM AUG 62.5X5 RL/LM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR DST FEM AUG 67.5X10 LL/R
|
Facility
|
IP
|
$8,420.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.27 |
| Max. Negotiated Rate |
$8,084.07 |
| Rate for Payer: Aetna Commercial |
$6,484.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.31
|
| Rate for Payer: Cash Price |
$4,210.45
|
| Rate for Payer: Cigna Commercial |
$6,989.36
|
| Rate for Payer: First Health Commercial |
$7,999.86
|
| Rate for Payer: Humana Commercial |
$7,157.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,326.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,810.43
|
| Rate for Payer: PHCS Commercial |
$8,084.07
|
| Rate for Payer: United Healthcare All Payer |
$7,410.40
|
|
|
VANDR DST FEM AUG 67.5X10 LL/R
|
Facility
|
OP
|
$8,420.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.27 |
| Max. Negotiated Rate |
$8,084.07 |
| Rate for Payer: Aetna Commercial |
$6,484.10
|
| Rate for Payer: Anthem Medicaid |
$2,895.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.31
|
| Rate for Payer: Cash Price |
$4,210.45
|
| Rate for Payer: Cigna Commercial |
$6,989.36
|
| Rate for Payer: First Health Commercial |
$7,999.86
|
| Rate for Payer: Humana Commercial |
$7,157.77
|
| Rate for Payer: Humana KY Medicaid |
$2,895.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,326.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,810.43
|
| Rate for Payer: PHCS Commercial |
$8,084.07
|
| Rate for Payer: United Healthcare All Payer |
$7,410.40
|
|
|
VANDR DST FEM AUG 67.5X10 RL/L
|
Facility
|
OP
|
$8,420.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.27 |
| Max. Negotiated Rate |
$8,084.07 |
| Rate for Payer: Aetna Commercial |
$6,484.10
|
| Rate for Payer: Anthem Medicaid |
$2,895.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.31
|
| Rate for Payer: Cash Price |
$4,210.45
|
| Rate for Payer: Cigna Commercial |
$6,989.36
|
| Rate for Payer: First Health Commercial |
$7,999.86
|
| Rate for Payer: Humana Commercial |
$7,157.77
|
| Rate for Payer: Humana KY Medicaid |
$2,895.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,326.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,810.43
|
| Rate for Payer: PHCS Commercial |
$8,084.07
|
| Rate for Payer: United Healthcare All Payer |
$7,410.40
|
|
|
VANDR DST FEM AUG 67.5X10 RL/L
|
Facility
|
IP
|
$8,420.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.27 |
| Max. Negotiated Rate |
$8,084.07 |
| Rate for Payer: Aetna Commercial |
$6,484.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.31
|
| Rate for Payer: Cash Price |
$4,210.45
|
| Rate for Payer: Cigna Commercial |
$6,989.36
|
| Rate for Payer: First Health Commercial |
$7,999.86
|
| Rate for Payer: Humana Commercial |
$7,157.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,326.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,810.43
|
| Rate for Payer: PHCS Commercial |
$8,084.07
|
| Rate for Payer: United Healthcare All Payer |
$7,410.40
|
|
|
VANDR DST FEM AUG 67.5X5 RL/LM
|
Facility
|
IP
|
$8,323.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.10 |
| Max. Negotiated Rate |
$7,990.72 |
| Rate for Payer: Aetna Commercial |
$6,409.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,492.46
|
| Rate for Payer: Cash Price |
$4,161.84
|
| Rate for Payer: Cigna Commercial |
$6,908.65
|
| Rate for Payer: First Health Commercial |
$7,907.49
|
| Rate for Payer: Humana Commercial |
$7,075.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,825.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,142.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,324.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,242.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,658.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,241.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,743.33
|
| Rate for Payer: PHCS Commercial |
$7,990.72
|
| Rate for Payer: United Healthcare All Payer |
$7,324.83
|
|
|
VANDR DST FEM AUG 67.5X5 RL/LM
|
Facility
|
OP
|
$8,323.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.10 |
| Max. Negotiated Rate |
$7,990.72 |
| Rate for Payer: Aetna Commercial |
$6,409.23
|
| Rate for Payer: Anthem Medicaid |
$2,862.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,492.46
|
| Rate for Payer: Cash Price |
$4,161.84
|
| Rate for Payer: Cigna Commercial |
$6,908.65
|
| Rate for Payer: First Health Commercial |
$7,907.49
|
| Rate for Payer: Humana Commercial |
$7,075.12
|
| Rate for Payer: Humana KY Medicaid |
$2,862.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,891.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,825.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,142.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,497.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,919.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,324.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,242.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,658.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,241.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,743.33
|
| Rate for Payer: PHCS Commercial |
$7,990.72
|
| Rate for Payer: United Healthcare All Payer |
$7,324.83
|
|
|
VANDR PST FEM AUG 57.5X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR PST FEM AUG 57.5X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR PST FEM AUG 62.5X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR PST FEM AUG 62.5X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR PST FEM AUG 67.5X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR PST FEM AUG 67.5X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR PST FEM AUG 67.5X5 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR PST FEM AUG 67.5X5 RL/LM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDR SSK 360 PS TIB BRG 10X59
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDR SSK 360 PS TIB BRG 10X59
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDR SSK 360 PS TIB BRG 12X59
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
