VANGUARD TIB BEAR PS 63/67*14
|
Facility
|
IP
|
$8,932.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,161.16 |
Max. Negotiated Rate |
$8,574.72 |
Rate for Payer: Aetna Commercial |
$6,877.64
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
Rate for Payer: Cash Price |
$4,466.00
|
Rate for Payer: Cigna Commercial |
$7,413.56
|
Rate for Payer: First Health Commercial |
$8,485.40
|
Rate for Payer: Humana Commercial |
$7,592.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
Rate for Payer: PHCS Commercial |
$8,574.72
|
Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
VANGUARD TIB BEAR PS 63/67*14
|
Facility
|
OP
|
$8,932.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,161.16 |
Max. Negotiated Rate |
$8,574.72 |
Rate for Payer: Aetna Commercial |
$6,877.64
|
Rate for Payer: Anthem Medicaid |
$3,071.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
Rate for Payer: Cash Price |
$4,466.00
|
Rate for Payer: Cigna Commercial |
$7,413.56
|
Rate for Payer: First Health Commercial |
$8,485.40
|
Rate for Payer: Humana Commercial |
$7,592.20
|
Rate for Payer: Humana KY Medicaid |
$3,071.71
|
Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
Rate for Payer: PHCS Commercial |
$8,574.72
|
Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
VANGUARD TIB BEAR PS 63/67*18
|
Facility
|
OP
|
$8,932.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,161.16 |
Max. Negotiated Rate |
$8,574.72 |
Rate for Payer: Aetna Commercial |
$6,877.64
|
Rate for Payer: Anthem Medicaid |
$3,071.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
Rate for Payer: Cash Price |
$4,466.00
|
Rate for Payer: Cigna Commercial |
$7,413.56
|
Rate for Payer: First Health Commercial |
$8,485.40
|
Rate for Payer: Humana Commercial |
$7,592.20
|
Rate for Payer: Humana KY Medicaid |
$3,071.71
|
Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
Rate for Payer: PHCS Commercial |
$8,574.72
|
Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
VANGUARD TIB BEAR PS 63/67*18
|
Facility
|
IP
|
$8,932.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,161.16 |
Max. Negotiated Rate |
$8,574.72 |
Rate for Payer: Aetna Commercial |
$6,877.64
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
Rate for Payer: Cash Price |
$4,466.00
|
Rate for Payer: Cigna Commercial |
$7,413.56
|
Rate for Payer: First Health Commercial |
$8,485.40
|
Rate for Payer: Humana Commercial |
$7,592.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
Rate for Payer: PHCS Commercial |
$8,574.72
|
Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
VANGUARD VNGD CR TIB BRG 59X10
|
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 VNGD CR TIB BRG 59X10
|
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 VNGD CR TIB BRG 59X11
|
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 VNGD CR TIB BRG 59X11
|
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 VNGD CR TIB BRG 59X12
|
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 VNGD CR TIB BRG 59X12
|
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 VNGD CR TIB BRG 59X13
|
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 VNGD CR TIB BRG 59X13
|
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 VNGD CR TIB BRG 59X14
|
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 VNGD CR TIB BRG 59X14
|
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 VNGD CR TIB BRG 59X16
|
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 VNGD CR TIB BRG 59X16
|
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 VNGD CR TIB BRG 59X18
|
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 VNGD CR TIB BRG 59X18
|
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
|
|
VAPRISOL 20MG AMP
|
Facility
|
IP
|
$1,833.32
|
|
Service Code
|
HCPCS J3490
|
Hospital Charge Code |
25003557
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$238.33 |
Max. Negotiated Rate |
$1,759.99 |
Rate for Payer: Aetna Commercial |
$1,411.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,429.99
|
Rate for Payer: Cash Price |
$916.66
|
Rate for Payer: Cigna Commercial |
$1,521.66
|
Rate for Payer: First Health Commercial |
$1,741.65
|
Rate for Payer: Humana Commercial |
$1,558.32
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,503.32
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.99
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$550.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,613.32
|
Rate for Payer: Ohio Health Group HMO |
$1,374.99
|
Rate for Payer: Ohio Health Group PPO Differential |
$366.66
|
Rate for Payer: Ohio Health Group PPO No Differential |
$238.33
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.33
|
Rate for Payer: PHCS Commercial |
$1,759.99
|
Rate for Payer: United Healthcare All Payer |
$1,613.32
|
|
VAPRISOL 20MG AMP
|
Facility
|
OP
|
$1,833.32
|
|
Service Code
|
HCPCS J3490
|
Hospital Charge Code |
25003557
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$238.33 |
Max. Negotiated Rate |
$1,759.99 |
Rate for Payer: Aetna Commercial |
$1,411.66
|
Rate for Payer: Anthem Medicaid |
$630.48
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,429.99
|
Rate for Payer: Cash Price |
$916.66
|
Rate for Payer: Cigna Commercial |
$1,521.66
|
Rate for Payer: First Health Commercial |
$1,741.65
|
Rate for Payer: Humana Commercial |
$1,558.32
|
Rate for Payer: Humana KY Medicaid |
$630.48
|
Rate for Payer: Kentucky WC Medicaid |
$636.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,503.32
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.99
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$550.00
|
Rate for Payer: Molina Healthcare Medicaid |
$643.13
|
Rate for Payer: Ohio Health Choice Commercial |
$1,613.32
|
Rate for Payer: Ohio Health Group HMO |
$1,374.99
|
Rate for Payer: Ohio Health Group PPO Differential |
$366.66
|
Rate for Payer: Ohio Health Group PPO No Differential |
$238.33
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.33
|
Rate for Payer: PHCS Commercial |
$1,759.99
|
Rate for Payer: United Healthcare All Payer |
$1,613.32
|
|
VAQTA 50U/1ML (HEP A ADULT)
|
Facility
|
IP
|
$349.57
|
|
Service Code
|
HCPCS 90632
|
Hospital Charge Code |
25000011
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$45.44 |
Max. Negotiated Rate |
$335.59 |
Rate for Payer: Aetna Commercial |
$269.17
|
Rate for Payer: Anthem POS/PPO/Traditional |
$272.66
|
Rate for Payer: Cash Price |
$174.78
|
Rate for Payer: Cigna Commercial |
$290.14
|
Rate for Payer: First Health Commercial |
$332.09
|
Rate for Payer: Humana Commercial |
$297.13
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$286.65
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.98
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$104.87
|
Rate for Payer: Ohio Health Choice Commercial |
$307.62
|
Rate for Payer: Ohio Health Group HMO |
$262.18
|
Rate for Payer: Ohio Health Group PPO Differential |
$69.91
|
Rate for Payer: Ohio Health Group PPO No Differential |
$45.44
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.37
|
Rate for Payer: PHCS Commercial |
$335.59
|
Rate for Payer: United Healthcare All Payer |
$307.62
|
|
VAQTA 50U/1ML (HEP A ADULT)
|
Facility
|
OP
|
$349.57
|
|
Service Code
|
HCPCS 90632
|
Hospital Charge Code |
25000011
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$45.44 |
Max. Negotiated Rate |
$335.59 |
Rate for Payer: Aetna Commercial |
$269.17
|
Rate for Payer: Anthem Medicaid |
$120.22
|
Rate for Payer: Anthem POS/PPO/Traditional |
$272.66
|
Rate for Payer: Cash Price |
$174.78
|
Rate for Payer: Cigna Commercial |
$290.14
|
Rate for Payer: First Health Commercial |
$332.09
|
Rate for Payer: Humana Commercial |
$297.13
|
Rate for Payer: Humana KY Medicaid |
$120.22
|
Rate for Payer: Kentucky WC Medicaid |
$121.44
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$286.65
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.98
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$104.87
|
Rate for Payer: Molina Healthcare Medicaid |
$122.63
|
Rate for Payer: Ohio Health Choice Commercial |
$307.62
|
Rate for Payer: Ohio Health Group HMO |
$262.18
|
Rate for Payer: Ohio Health Group PPO Differential |
$69.91
|
Rate for Payer: Ohio Health Group PPO No Differential |
$45.44
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.37
|
Rate for Payer: PHCS Commercial |
$335.59
|
Rate for Payer: United Healthcare All Payer |
$307.62
|
|
VARIAX FIBULA PLATE 10 H
|
Facility
|
IP
|
$4,972.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$646.36 |
Max. Negotiated Rate |
$4,773.12 |
Rate for Payer: Aetna Commercial |
$3,828.44
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,878.16
|
Rate for Payer: Cash Price |
$2,486.00
|
Rate for Payer: Cigna Commercial |
$4,126.76
|
Rate for Payer: First Health Commercial |
$4,723.40
|
Rate for Payer: Humana Commercial |
$4,226.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,077.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,669.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,491.60
|
Rate for Payer: Ohio Health Choice Commercial |
$4,375.36
|
Rate for Payer: Ohio Health Group HMO |
$3,729.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$994.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$646.36
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,541.32
|
Rate for Payer: PHCS Commercial |
$4,773.12
|
Rate for Payer: United Healthcare All Payer |
$4,375.36
|
|
VARIAX FIBULA PLATE 10 H
|
Facility
|
OP
|
$4,972.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$646.36 |
Max. Negotiated Rate |
$4,773.12 |
Rate for Payer: Aetna Commercial |
$3,828.44
|
Rate for Payer: Anthem Medicaid |
$1,709.87
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,878.16
|
Rate for Payer: Cash Price |
$2,486.00
|
Rate for Payer: Cigna Commercial |
$4,126.76
|
Rate for Payer: First Health Commercial |
$4,723.40
|
Rate for Payer: Humana Commercial |
$4,226.20
|
Rate for Payer: Humana KY Medicaid |
$1,709.87
|
Rate for Payer: Kentucky WC Medicaid |
$1,727.27
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,077.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,669.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,491.60
|
Rate for Payer: Molina Healthcare Medicaid |
$1,744.18
|
Rate for Payer: Ohio Health Choice Commercial |
$4,375.36
|
Rate for Payer: Ohio Health Group HMO |
$3,729.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$994.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$646.36
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,541.32
|
Rate for Payer: PHCS Commercial |
$4,773.12
|
Rate for Payer: United Healthcare All Payer |
$4,375.36
|
|
VARIAX FIBULA PLATE 11 H
|
Facility
|
IP
|
$4,972.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$646.36 |
Max. Negotiated Rate |
$4,773.12 |
Rate for Payer: Aetna Commercial |
$3,828.44
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,878.16
|
Rate for Payer: Cash Price |
$2,486.00
|
Rate for Payer: Cigna Commercial |
$4,126.76
|
Rate for Payer: First Health Commercial |
$4,723.40
|
Rate for Payer: Humana Commercial |
$4,226.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,077.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,669.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,491.60
|
Rate for Payer: Ohio Health Choice Commercial |
$4,375.36
|
Rate for Payer: Ohio Health Group HMO |
$3,729.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$994.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$646.36
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,541.32
|
Rate for Payer: PHCS Commercial |
$4,773.12
|
Rate for Payer: United Healthcare All Payer |
$4,375.36
|
|