|
VANDUAR SSK PSC INTLK FEM 80 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 80 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 80 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 80 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 PS TIB BRG S 10X59
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 10X59
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 12X59
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 12X59
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 14X59
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 14X59
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 16X59
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 16X59
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 18X59
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 18X59
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 20X59
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 20X59
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 22X59
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 22X59
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 24X59
|
Facility
|
IP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUAR SSK PS TIB BRG S 24X59
|
Facility
|
OP
|
$16,028.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,808.51 |
| Max. Negotiated Rate |
$15,387.23 |
| Rate for Payer: Aetna Commercial |
$12,341.84
|
| Rate for Payer: Anthem Medicaid |
$5,512.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,502.12
|
| Rate for Payer: Cash Price |
$8,014.18
|
| Rate for Payer: Cigna Commercial |
$13,303.54
|
| Rate for Payer: First Health Commercial |
$15,226.94
|
| Rate for Payer: Humana Commercial |
$13,624.11
|
| Rate for Payer: Humana KY Medicaid |
$5,512.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,143.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,828.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,808.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,622.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,104.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,021.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,822.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,944.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,059.57
|
| Rate for Payer: PHCS Commercial |
$15,387.23
|
| Rate for Payer: United Healthcare All Payer |
$14,104.96
|
|
|
VANDUR DIS AUG TRL 55*10 LL/RM
|
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
|
|
|
VANDUR DIS AUG TRL 55*10 LL/RM
|
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
|
|
|
VANDUR DIS AUG TRL 55*10 RL/LM
|
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
|
|
|
VANDUR DIS AUG TRL 55*10 RL/LM
|
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
|
|
|
VANDUR DIS AUG TRL 55*15 LL/RM
|
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
|
|
