|
VANDUR DST FEM AUG 60X10 LL/RM
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 65X10 LL/RM
|
Facility
|
IP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 65X10 LL/RM
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 65X10 RL/LM
|
Facility
|
IP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 65X10 RL/LM
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 70X10 LL/RM
|
Facility
|
IP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 70X10 LL/RM
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 70X10 RL/LM
|
Facility
|
OP
|
$8,420.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.27 |
| Max. Negotiated Rate |
$8,084.07 |
| Rate for Payer: Aetna Commercial |
$6,484.10
|
| Rate for Payer: Anthem Medicaid |
$2,895.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.31
|
| Rate for Payer: Cash Price |
$4,210.45
|
| Rate for Payer: Cigna Commercial |
$6,989.36
|
| Rate for Payer: First Health Commercial |
$7,999.86
|
| Rate for Payer: Humana Commercial |
$7,157.77
|
| Rate for Payer: Humana KY Medicaid |
$2,895.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,326.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,810.43
|
| Rate for Payer: PHCS Commercial |
$8,084.07
|
| Rate for Payer: United Healthcare All Payer |
$7,410.40
|
|
|
VANDUR DST FEM AUG 70X10 RL/LM
|
Facility
|
IP
|
$8,420.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.27 |
| Max. Negotiated Rate |
$8,084.07 |
| Rate for Payer: Aetna Commercial |
$6,484.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.31
|
| Rate for Payer: Cash Price |
$4,210.45
|
| Rate for Payer: Cigna Commercial |
$6,989.36
|
| Rate for Payer: First Health Commercial |
$7,999.86
|
| Rate for Payer: Humana Commercial |
$7,157.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,326.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,810.43
|
| Rate for Payer: PHCS Commercial |
$8,084.07
|
| Rate for Payer: United Healthcare All Payer |
$7,410.40
|
|
|
VANDUR DST FEM AUG 75X10 LL/RM
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 75X10 LL/RM
|
Facility
|
IP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 75X10 RL/LM
|
Facility
|
IP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 75X10 RL/LM
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 80X10 LL/RM
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 80X10 LL/RM
|
Facility
|
IP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 80X10 RL/LM
|
Facility
|
IP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR DST FEM AUG 80X10 RL/LM
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANDUR E1 CRL TIB BRG 79/83*16
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUR E1 CRL TIB BRG 79/83*16
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUR E1 CRL TIB BRG 79/83*18
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUR E1 CRL TIB BRG 79/83*18
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*10
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*10
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*11
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANDUR E1 CRL TIB BRG 87/91*11
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
