|
VANGUARD PS OPEN POR FEM 70 R
|
Facility
|
OP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem Medicaid |
$5,864.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Humana KY Medicaid |
$5,864.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,924.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,982.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANGUARD PS OPEN POR FEM 75 L
|
Facility
|
OP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem Medicaid |
$5,864.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Humana KY Medicaid |
$5,864.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,924.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,982.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANGUARD PS OPEN POR FEM 75 L
|
Facility
|
IP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANGUARD PS OPEN POR FEM 75 R
|
Facility
|
IP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANGUARD PS OPEN POR FEM 75 R
|
Facility
|
OP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem Medicaid |
$5,864.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Humana KY Medicaid |
$5,864.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,924.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,982.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANGUARD PS OPEN POR FEM 80 L
|
Facility
|
OP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem Medicaid |
$5,864.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Humana KY Medicaid |
$5,864.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,924.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,982.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANGUARD PS OPEN POR FEM 80 L
|
Facility
|
IP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANGUARD PS OPEN POR FEM 80 R
|
Facility
|
IP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANGUARD PS OPEN POR FEM 80 R
|
Facility
|
OP
|
$17,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,116.20 |
| Max. Negotiated Rate |
$16,371.84 |
| Rate for Payer: Aetna Commercial |
$13,131.58
|
| Rate for Payer: Anthem Medicaid |
$5,864.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,302.12
|
| Rate for Payer: Cash Price |
$8,527.00
|
| Rate for Payer: Cigna Commercial |
$14,154.82
|
| Rate for Payer: First Health Commercial |
$16,201.30
|
| Rate for Payer: Humana Commercial |
$14,495.90
|
| Rate for Payer: Humana KY Medicaid |
$5,864.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,924.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,984.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,585.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,116.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,982.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,007.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,790.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,836.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,767.26
|
| Rate for Payer: PHCS Commercial |
$16,371.84
|
| Rate for Payer: United Healthcare All Payer |
$15,007.52
|
|
|
VANGUARD PS OPN INTL FEM 55 LT
|
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 PS OPN INTL FEM 55 LT
|
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 PS OPN INTL FEM 55 RT
|
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 PS OPN INTL FEM 55 RT
|
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 PS OPN INTL FEM 60 LT
|
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 PS OPN INTL FEM 60 LT
|
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 PS OPN INTL FEM 60 RT
|
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 PS OPN INTL FEM 60 RT
|
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 PS OPN INTL FEM 65 LT
|
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 PS OPN INTL FEM 65 LT
|
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 PS OPN INTL FEM 65 RT
|
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 PS OPN INTL FEM 65 RT
|
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 PS OPN INTL FEM 70 LT
|
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 PS OPN INTL FEM 70 LT
|
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 PS OPN INTL FEM 70 RT
|
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 PS OPN INTL FEM 70 RT
|
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
|
|
