|
VANGUARD PS OPN INTL FEM 75 L
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD PS OPN INTL FEM 75 L
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD PS OPN INTL FEM 75 R
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD PS OPN INTL FEM 75 R
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD PS OPN INTL FEM 80 L
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD PS OPN INTL FEM 80 L
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD PS OPN INTL FEM 80 R
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD PS OPN INTL FEM 80 R
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD PS+ TIB BRG 10*59
|
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 PS+ TIB BRG 10*59
|
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 PS+ TIB BRG 10*63/67
|
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 PS+ TIB BRG 10*63/67
|
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 PS+ TIB BRG 10*71/75
|
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 PS+ TIB BRG 10*71/75
|
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 PS+ TIB BRG 10*79/83
|
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 PS+ TIB BRG 10*79/83
|
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 PS+ TIB BRG 10*87/91
|
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 PS+ TIB BRG 10*87/91
|
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 PS+ TIB BRG 12*59
|
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 PS+ TIB BRG 12*59
|
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 PS+ TIB BRG 12*63/67
|
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 PS+ TIB BRG 12*63/67
|
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 PS+ TIB BRG 12*71/75
|
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 PS+ TIB BRG 12*71/75
|
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 PS+ TIB BRG 12*79/83
|
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
|
|
