|
VANDR SSK PS TIBBRG S 10X63/67
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 10X63/67
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 10X71/75
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 10X71/75
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 12X63/67
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 12X63/67
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 14X63/67
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 14X63/67
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 14X71/75
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 14X71/75
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 16X63/67
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 16X63/67
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 16X71/75
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 16X71/75
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 18X63/67
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 18X63/67
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 18X71/75
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 18X71/75
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 20X63/67
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 20X63/67
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 20X71/75
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 20X71/75
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 22X63/67
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 22X63/67
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDR SSK PS TIBBRG S 22X71/75
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
