|
VANGUARD PS OPEN POR FEM 60 L
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 60 R
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 60 R
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 65 L
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 65 L
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 65 R
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 65 R
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 70 L
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 70 L
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 70 R
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 70 R
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 75 L
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 75 L
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 75 R
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 75 R
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 80 L
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 80 L
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 80 R
|
Facility
|
OP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem Medicaid |
$5,678.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Humana KY Medicaid |
$5,678.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,736.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPEN POR FEM 80 R
|
Facility
|
IP
|
$16,512.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,146.56 |
| Max. Negotiated Rate |
$15,851.52 |
| Rate for Payer: Aetna Commercial |
$12,714.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,879.36
|
| Rate for Payer: Cash Price |
$8,256.00
|
| Rate for Payer: Cigna Commercial |
$13,704.96
|
| Rate for Payer: First Health Commercial |
$15,686.40
|
| Rate for Payer: Humana Commercial |
$14,035.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,539.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,185.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,953.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,530.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,302.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,146.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,118.72
|
| Rate for Payer: PHCS Commercial |
$15,851.52
|
| Rate for Payer: United Healthcare All Payer |
$14,530.56
|
|
|
VANGUARD PS OPN INTL FEM 55 LT
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANGUARD PS OPN INTL FEM 55 LT
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANGUARD PS OPN INTL FEM 55 RT
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANGUARD PS OPN INTL FEM 55 RT
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANGUARD PS OPN INTL FEM 60 LT
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
VANGUARD PS OPN INTL FEM 60 LT
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
