|
VANDUR PST AUG TRL 75*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 PST AUG TRL 75*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 PST AUG TRL 75*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 PST AUG TRL 80*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 PST AUG TRL 80*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 PST AUG TRL 80*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 PST AUG TRL 80*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 SSK PS TIB BRG 10*87/91
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 10*87/91
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 10X63/67
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 10X63/67
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 10X71/75
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 10X71/75
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 10X79/83
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 10X79/83
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 12*87/91
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 12*87/91
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 12X63/67
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 12X63/67
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 12X71/75
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 12X71/75
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 12X79/83
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 12X79/83
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 14*87/91
|
Facility
|
OP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem Medicaid |
$5,443.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Humana KY Medicaid |
$5,443.44
|
| Rate for Payer: Kentucky WC Medicaid |
$5,498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,552.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
|
VANDUR SSK PS TIB BRG 14*87/91
|
Facility
|
IP
|
$15,828.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,748.57 |
| Max. Negotiated Rate |
$15,195.42 |
| Rate for Payer: Aetna Commercial |
$12,187.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,346.28
|
| Rate for Payer: Cash Price |
$7,914.28
|
| Rate for Payer: Cigna Commercial |
$13,137.70
|
| Rate for Payer: First Health Commercial |
$15,037.13
|
| Rate for Payer: Humana Commercial |
$13,454.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,979.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,681.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,748.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,929.13
|
| Rate for Payer: Ohio Health Group HMO |
$11,871.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,662.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,770.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,921.71
|
| Rate for Payer: PHCS Commercial |
$15,195.42
|
| Rate for Payer: United Healthcare All Payer |
$13,929.13
|
|
