|
VANGUARD CR ILOK FEM 65MM 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 65MM 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 65MM 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
|
|
|
VANGUARD CR ILOK FEM 65MM 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 67.5MM 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 67.5MM 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 67.5MM 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 67.5MM 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
|
|
|
VANGUARD CR ILOK FEM 70MM 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 70MM 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 70MM 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
|
|
|
VANGUARD CR ILOK FEM 70MM 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 72.5MM 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 72.5MM 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 72.5MM 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
|
|
|
VANGUARD CR ILOK FEM 72.5MM 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 75MM 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 75MM 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 75MM 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
|
|
|
VANGUARD CR ILOK FEM 75MM 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 80MM 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 80MM 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 80MM 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 80MM 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
|
|
|
VANGUARD CRL TIB BRG 59X10
|
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
|
|
