|
VANGUARD CRL TIB BRG 79/83X14
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANGUARD CR TIB BEARING 16MM
|
Facility
|
OP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem Medicaid |
$2,824.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Humana KY Medicaid |
$2,824.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,852.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,880.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
VANGUARD CR TIB BEARING 16MM
|
Facility
|
IP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
VANGUARD CR TIB BEARING 18MM
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
VANGUARD CR TIB BEARING 18MM
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
VANGUARD CR TIB BRG 87*91*11
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANGUARD CR TIB BRG 87*91*11
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANGUARD CR TIB BRG 87*91*12
|
Facility
|
OP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem Medicaid |
$2,824.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Humana KY Medicaid |
$2,824.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,852.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,880.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
VANGUARD CR TIB BRG 87*91*12
|
Facility
|
IP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
VANGUARD CR TIB BRG 87*91*13
|
Facility
|
IP
|
$8,829.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,648.86 |
| Max. Negotiated Rate |
$8,476.34 |
| Rate for Payer: Aetna Commercial |
$6,798.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,887.03
|
| Rate for Payer: Cash Price |
$4,414.76
|
| Rate for Payer: Cigna Commercial |
$7,328.50
|
| Rate for Payer: First Health Commercial |
$8,388.04
|
| Rate for Payer: Humana Commercial |
$7,505.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,240.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,516.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,648.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,769.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,622.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,063.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,681.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,092.37
|
| Rate for Payer: PHCS Commercial |
$8,476.34
|
| Rate for Payer: United Healthcare All Payer |
$7,769.98
|
|
|
VANGUARD CR TIB BRG 87*91*13
|
Facility
|
OP
|
$8,829.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,648.86 |
| Max. Negotiated Rate |
$8,476.34 |
| Rate for Payer: Aetna Commercial |
$6,798.73
|
| Rate for Payer: Anthem Medicaid |
$3,036.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,887.03
|
| Rate for Payer: Cash Price |
$4,414.76
|
| Rate for Payer: Cigna Commercial |
$7,328.50
|
| Rate for Payer: First Health Commercial |
$8,388.04
|
| Rate for Payer: Humana Commercial |
$7,505.09
|
| Rate for Payer: Humana KY Medicaid |
$3,036.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,067.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,240.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,516.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,648.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,097.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,769.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,622.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,063.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,681.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,092.37
|
| Rate for Payer: PHCS Commercial |
$8,476.34
|
| Rate for Payer: United Healthcare All Payer |
$7,769.98
|
|
|
VANGUARD CR TIB BRG 87*91*14
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANGUARD CR TIB BRG 87*91*14
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANGUARD CR TIB BRG 87*91*16
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANGUARD CR TIB BRG 87*91*16
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
VANGUARD CR TIB BRG 87*91*18
|
Facility
|
OP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem Medicaid |
$2,824.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Humana KY Medicaid |
$2,824.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,852.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,880.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
VANGUARD CR TIB BRG 87*91*18
|
Facility
|
IP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
VANGUARD DIST FEM AUG 55X10
|
Facility
|
IP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANGUARD DIST FEM AUG 55X10
|
Facility
|
OP
|
$8,891.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.33 |
| Max. Negotiated Rate |
$8,535.46 |
| Rate for Payer: Aetna Commercial |
$6,846.15
|
| Rate for Payer: Anthem Medicaid |
$3,057.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.06
|
| Rate for Payer: Cash Price |
$4,445.55
|
| Rate for Payer: Cigna Commercial |
$7,379.61
|
| Rate for Payer: First Health Commercial |
$8,446.55
|
| Rate for Payer: Humana Commercial |
$7,557.44
|
| Rate for Payer: Humana KY Medicaid |
$3,057.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,290.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,561.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,112.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,735.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,134.86
|
| Rate for Payer: PHCS Commercial |
$8,535.46
|
| Rate for Payer: United Healthcare All Payer |
$7,824.17
|
|
|
VANGUARD DS FM AUG 55*15 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
|
|
|
VANGUARD DS FM AUG 55*15 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
|
|
|
VANGUARD DS FM AUG 60*15 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
|
|
|
VANGUARD DS FM AUG 60*15 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
|
|
|
VANGUARD DS FM AUG 60*5 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
|
|
|
VANGUARD DS FM AUG 60*5 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
|
|
