|
VANDUR POST FEM AUG 55X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 60X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 60X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 65X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 65X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 65X5 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 65X5 RL/LM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 70X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 70X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 70X5 RL/LM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 70X5 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 75X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 75X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 75X5 RL/LM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 75X5 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 80X5 RL/LM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR POST FEM AUG 80X5 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANDUR PS OPN INTL FEM 57.5 LT
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANDUR PS OPN INTL FEM 57.5 LT
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANDUR PS OPN INTL FEM 57.5 RT
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANDUR PS OPN INTL FEM 57.5 RT
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANDUR PS OPN INTL FEM 62.5 LT
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANDUR PS OPN INTL FEM 62.5 LT
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANDUR PS OPN INTL FEM 62.5 RT
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANDUR PS OPN INTL FEM 62.5 RT
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
