|
VANDUAR PSC TIB BRG S 18*71/75
|
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
|
|
|
VANDUAR PSC TIB BRG S 18*71/75
|
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
|
|
|
VANDUAR PSC TIB BRG S 20*63/67
|
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
|
|
|
VANDUAR PSC TIB BRG S 20*63/67
|
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
|
|
|
VANDUAR PSC TIB BRG S 20*71/75
|
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
|
|
|
VANDUAR PSC TIB BRG S 20*71/75
|
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
|
|
|
VANDUAR PSC TIB BRG S 22*63/67
|
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
|
|
|
VANDUAR PSC TIB BRG S 22*63/67
|
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
|
|
|
VANDUAR PSC TIB BRG S 22*71/75
|
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
|
|
|
VANDUAR PSC TIB BRG S 22*71/75
|
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
|
|
|
VANDUAR PSC TIB BRG S 24*63/67
|
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
|
|
|
VANDUAR PSC TIB BRG S 24*63/67
|
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
|
|
|
VANDUAR PSC TIB BRG S 24*71/75
|
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
|
|
|
VANDUAR PSC TIB BRG S 24*71/75
|
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
|
|
|
VANDUAR PS OPEN POR FEM 57.5 L
|
Facility
|
OP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem Medicaid |
$5,864.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Humana KY Medicaid |
$5,864.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,924.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,982.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANDUAR PS OPEN POR FEM 57.5 L
|
Facility
|
IP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANDUAR PS OPEN POR FEM 57.5 R
|
Facility
|
IP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANDUAR PS OPEN POR FEM 57.5 R
|
Facility
|
OP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem Medicaid |
$5,864.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Humana KY Medicaid |
$5,864.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,924.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,982.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANDUAR PS OPEN POR FEM 62.5 L
|
Facility
|
IP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANDUAR PS OPEN POR FEM 62.5 L
|
Facility
|
OP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem Medicaid |
$5,864.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Humana KY Medicaid |
$5,864.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,924.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,982.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANDUAR PS OPEN POR FEM 62.5 R
|
Facility
|
IP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANDUAR PS OPEN POR FEM 62.5 R
|
Facility
|
OP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem Medicaid |
$5,864.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Humana KY Medicaid |
$5,864.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,924.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,982.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANDUAR PS OPEN POR FEM 67.5 L
|
Facility
|
IP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANDUAR PS OPEN POR FEM 67.5 L
|
Facility
|
OP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem Medicaid |
$5,864.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Humana KY Medicaid |
$5,864.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,924.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,982.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANDUAR PS OPEN POR FEM 67.5 R
|
Facility
|
IP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
