|
VANGRD DIST FEM AUG75X10 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANGRD DIST FEM AUG80X10 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANGRD DIST FEM AUG80X10 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANGRD DIST FEM AUG80X10 RL/LM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANGRD DIST FEM AUG80X10 RL/LM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
VANGRD SSK PSCTIB BRG 22X63/67
|
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
|
|
|
VANGRD SSK PSCTIB BRG 22X63/67
|
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
|
|
|
VANGUARD AUGMENT BOLT
|
Facility
|
IP
|
$3,197.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.10 |
| Max. Negotiated Rate |
$3,069.12 |
| Rate for Payer: Aetna Commercial |
$2,461.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,493.66
|
| Rate for Payer: Cash Price |
$1,598.50
|
| Rate for Payer: Cigna Commercial |
$2,653.51
|
| Rate for Payer: First Health Commercial |
$3,037.15
|
| Rate for Payer: Humana Commercial |
$2,717.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,621.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,359.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,813.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,397.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,557.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,205.93
|
| Rate for Payer: PHCS Commercial |
$3,069.12
|
| Rate for Payer: United Healthcare All Payer |
$2,813.36
|
|
|
VANGUARD AUGMENT BOLT
|
Facility
|
OP
|
$3,197.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.10 |
| Max. Negotiated Rate |
$3,069.12 |
| Rate for Payer: Aetna Commercial |
$2,461.69
|
| Rate for Payer: Anthem Medicaid |
$1,099.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,493.66
|
| Rate for Payer: Cash Price |
$1,598.50
|
| Rate for Payer: Cigna Commercial |
$2,653.51
|
| Rate for Payer: First Health Commercial |
$3,037.15
|
| Rate for Payer: Humana Commercial |
$2,717.45
|
| Rate for Payer: Humana KY Medicaid |
$1,099.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,110.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,621.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,359.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,121.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,813.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,397.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,557.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,781.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,205.93
|
| Rate for Payer: PHCS Commercial |
$3,069.12
|
| Rate for Payer: United Healthcare All Payer |
$2,813.36
|
|
|
VANGUARD CR ILOK FEM 55MM L
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD CR ILOK FEM 55MM L
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD CR ILOK FEM 55MM R
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD CR ILOK FEM 55MM R
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD CR ILOK FEM 57.5MM L
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD CR ILOK FEM 57.5MM L
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD CR ILOK FEM 57.5MM R
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD CR ILOK FEM 57.5MM R
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD CR ILOK FEM 60MM L
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
VANGUARD CR ILOK FEM 60MM L
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
VANGUARD CR ILOK FEM 60MM R
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD CR ILOK FEM 60MM R
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD CR ILOK FEM 62.5MM L
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
VANGUARD CR ILOK FEM 62.5MM L
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
VANGUARD CR ILOK FEM 62.5MM R
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
VANGUARD CR ILOK FEM 62.5MM R
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
