|
VANDR SSK PSC TIB BRG 12X79/83
|
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 PSC TIB BRG 12X79/83
|
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 PSC TIB BRG 12X87/91
|
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 PSC TIB BRG 12X87/91
|
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 PSC TIB BRG 14X63/67
|
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 PSC TIB BRG 14X63/67
|
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 PSC TIB BRG 14X71/75
|
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 PSC TIB BRG 14X71/75
|
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 PSC TIB BRG 14X79/83
|
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 PSC TIB BRG 14X79/83
|
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 PSC TIB BRG 14X87/91
|
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 PSC TIB BRG 14X87/91
|
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 PSC TIB BRG 16X63/67
|
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 PSC TIB BRG 16X63/67
|
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 PSC TIB BRG 16X71/75
|
Facility
|
IP
|
$13,946.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.85 |
| Max. Negotiated Rate |
$13,388.33 |
| Rate for Payer: Aetna Commercial |
$10,738.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,878.02
|
| Rate for Payer: Cash Price |
$6,973.09
|
| Rate for Payer: Cigna Commercial |
$11,575.33
|
| Rate for Payer: First Health Commercial |
$13,248.87
|
| Rate for Payer: Humana Commercial |
$11,854.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,435.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,272.64
|
| Rate for Payer: Ohio Health Group HMO |
$10,459.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,156.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,133.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,622.86
|
| Rate for Payer: PHCS Commercial |
$13,388.33
|
| Rate for Payer: United Healthcare All Payer |
$12,272.64
|
|
|
VANDR SSK PSC TIB BRG 16X71/75
|
Facility
|
OP
|
$13,946.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.85 |
| Max. Negotiated Rate |
$13,388.33 |
| Rate for Payer: Aetna Commercial |
$10,738.56
|
| Rate for Payer: Anthem Medicaid |
$4,796.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,878.02
|
| Rate for Payer: Cash Price |
$6,973.09
|
| Rate for Payer: Cigna Commercial |
$11,575.33
|
| Rate for Payer: First Health Commercial |
$13,248.87
|
| Rate for Payer: Humana Commercial |
$11,854.25
|
| Rate for Payer: Humana KY Medicaid |
$4,796.09
|
| Rate for Payer: Kentucky WC Medicaid |
$4,844.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,435.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,892.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,272.64
|
| Rate for Payer: Ohio Health Group HMO |
$10,459.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,156.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,133.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,622.86
|
| Rate for Payer: PHCS Commercial |
$13,388.33
|
| Rate for Payer: United Healthcare All Payer |
$12,272.64
|
|
|
VANDR SSK PSC TIB BRG 16X79/83
|
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 PSC TIB BRG 16X79/83
|
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 PSC TIB BRG 16X87/91
|
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 PSC TIB BRG 16X87/91
|
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 PSC TIB BRG 18X63/67
|
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 PSC TIB BRG 18X63/67
|
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 PSC TIB BRG 18X71/75
|
Facility
|
IP
|
$13,946.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.85 |
| Max. Negotiated Rate |
$13,388.33 |
| Rate for Payer: Aetna Commercial |
$10,738.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,878.02
|
| Rate for Payer: Cash Price |
$6,973.09
|
| Rate for Payer: Cigna Commercial |
$11,575.33
|
| Rate for Payer: First Health Commercial |
$13,248.87
|
| Rate for Payer: Humana Commercial |
$11,854.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,435.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,272.64
|
| Rate for Payer: Ohio Health Group HMO |
$10,459.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,156.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,133.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,622.86
|
| Rate for Payer: PHCS Commercial |
$13,388.33
|
| Rate for Payer: United Healthcare All Payer |
$12,272.64
|
|
|
VANDR SSK PSC TIB BRG 18X71/75
|
Facility
|
OP
|
$13,946.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.85 |
| Max. Negotiated Rate |
$13,388.33 |
| Rate for Payer: Aetna Commercial |
$10,738.56
|
| Rate for Payer: Anthem Medicaid |
$4,796.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,878.02
|
| Rate for Payer: Cash Price |
$6,973.09
|
| Rate for Payer: Cigna Commercial |
$11,575.33
|
| Rate for Payer: First Health Commercial |
$13,248.87
|
| Rate for Payer: Humana Commercial |
$11,854.25
|
| Rate for Payer: Humana KY Medicaid |
$4,796.09
|
| Rate for Payer: Kentucky WC Medicaid |
$4,844.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,435.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,892.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,272.64
|
| Rate for Payer: Ohio Health Group HMO |
$10,459.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,156.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,133.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,622.86
|
| Rate for Payer: PHCS Commercial |
$13,388.33
|
| Rate for Payer: United Healthcare All Payer |
$12,272.64
|
|
|
VANDR SSK PSC TIB BRG 18X79/83
|
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
|
|
