|
VITALITY AVT DC/LEAD 8416
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY AVT DC/LEAD 8417
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY AVT DC/LEAD 8417
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY AVT DC/LEAD 8418
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY AVT DC/LEAD 8418
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY AVT DC/LEAD 8419
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY AVT DC/LEAD 8419
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY DS DR DC/LEAD 8426
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY DS DR DC/LEAD 8426
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY DS DR DC/LEAD 8427
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY DS DR DC/LEAD 8427
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY DS DR DC/LEAD 8428
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY DS DR DC/LEAD 8428
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY DS DR DC/LEAD 8429
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY DS DR DC/LEAD 8429
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY DS VR SC/LEAD 8446
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY DS VR SC/LEAD 8446
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY EL DC/LEAD 8436
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY EL DC/LEAD 8436
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY EL DC/LEAD 8437
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY EL DC/LEAD 8437
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY EL DC/LEAD 8438
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY EL DC/LEAD 8438
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY EL DC/LEAD 8439
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY EL DC/LEAD 8439
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
