|
VANDUAR PS OPEN POR FEM 67.5 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 72.5 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 72.5 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 72.5 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 72.5 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 SSK PSC INTLK FEM 55 L
|
Facility
|
IP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 55 L
|
Facility
|
OP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem Medicaid |
$13,890.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Humana KY Medicaid |
$13,890.98
|
| Rate for Payer: Kentucky WC Medicaid |
$14,032.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,169.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 55 R
|
Facility
|
OP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem Medicaid |
$13,890.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Humana KY Medicaid |
$13,890.98
|
| Rate for Payer: Kentucky WC Medicaid |
$14,032.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,169.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 55 R
|
Facility
|
IP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 60 L
|
Facility
|
IP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 60 L
|
Facility
|
OP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem Medicaid |
$13,890.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Humana KY Medicaid |
$13,890.98
|
| Rate for Payer: Kentucky WC Medicaid |
$14,032.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,169.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 60 R
|
Facility
|
IP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 60 R
|
Facility
|
OP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem Medicaid |
$13,890.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Humana KY Medicaid |
$13,890.98
|
| Rate for Payer: Kentucky WC Medicaid |
$14,032.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,169.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 65 L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
VANDUAR SSK PSC INTLK FEM 65 L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
VANDUAR SSK PSC INTLK FEM 65 R
|
Facility
|
IP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 65 R
|
Facility
|
OP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem Medicaid |
$13,890.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Humana KY Medicaid |
$13,890.98
|
| Rate for Payer: Kentucky WC Medicaid |
$14,032.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,169.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 70 L
|
Facility
|
IP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 70 L
|
Facility
|
OP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem Medicaid |
$13,890.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Humana KY Medicaid |
$13,890.98
|
| Rate for Payer: Kentucky WC Medicaid |
$14,032.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,169.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 70 R
|
Facility
|
IP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 70 R
|
Facility
|
OP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem Medicaid |
$13,890.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Humana KY Medicaid |
$13,890.98
|
| Rate for Payer: Kentucky WC Medicaid |
$14,032.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,169.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 75 L
|
Facility
|
OP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem Medicaid |
$13,890.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Humana KY Medicaid |
$13,890.98
|
| Rate for Payer: Kentucky WC Medicaid |
$14,032.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,169.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 75 L
|
Facility
|
IP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 75 R
|
Facility
|
IP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
|
VANDUAR SSK PSC INTLK FEM 75 R
|
Facility
|
OP
|
$40,392.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,117.75 |
| Max. Negotiated Rate |
$38,776.80 |
| Rate for Payer: Aetna Commercial |
$31,102.22
|
| Rate for Payer: Anthem Medicaid |
$13,890.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,506.15
|
| Rate for Payer: Cash Price |
$20,196.25
|
| Rate for Payer: Cigna Commercial |
$33,525.78
|
| Rate for Payer: First Health Commercial |
$38,372.88
|
| Rate for Payer: Humana Commercial |
$34,333.62
|
| Rate for Payer: Humana KY Medicaid |
$13,890.98
|
| Rate for Payer: Kentucky WC Medicaid |
$14,032.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,121.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,809.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,117.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,169.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,545.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,294.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,141.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,870.83
|
| Rate for Payer: PHCS Commercial |
$38,776.80
|
| Rate for Payer: United Healthcare All Payer |
$35,545.40
|
|
