|
VECTIBIX(PANTM)10MG 100MG/5ML
|
Facility
|
IP
|
$9,873.49
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
25002670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,962.05 |
| Max. Negotiated Rate |
$9,478.55 |
| Rate for Payer: Aetna Commercial |
$7,602.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,701.32
|
| Rate for Payer: Cash Price |
$4,936.74
|
| Rate for Payer: Cigna Commercial |
$8,195.00
|
| Rate for Payer: First Health Commercial |
$9,379.82
|
| Rate for Payer: Humana Commercial |
$8,392.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,096.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,286.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,962.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,688.67
|
| Rate for Payer: Ohio Health Group HMO |
$7,405.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,898.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,589.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,812.71
|
| Rate for Payer: PHCS Commercial |
$9,478.55
|
| Rate for Payer: United Healthcare All Payer |
$8,688.67
|
|
|
VECTIBIX(PANTM)10MG 100MG/5ML
|
Facility
|
OP
|
$9,873.49
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
25002670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.55 |
| Max. Negotiated Rate |
$9,478.55 |
| Rate for Payer: Aetna Commercial |
$7,602.59
|
| Rate for Payer: Anthem Medicaid |
$3,395.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,701.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.94
|
| Rate for Payer: Cash Price |
$4,936.74
|
| Rate for Payer: Cash Price |
$4,936.74
|
| Rate for Payer: Cigna Commercial |
$8,195.00
|
| Rate for Payer: First Health Commercial |
$9,379.82
|
| Rate for Payer: Humana Commercial |
$8,392.47
|
| Rate for Payer: Humana KY Medicaid |
$3,395.49
|
| Rate for Payer: Humana Medicare Advantage |
$172.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,430.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,096.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,286.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,463.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,688.67
|
| Rate for Payer: Ohio Health Group HMO |
$7,405.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,898.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,589.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,812.71
|
| Rate for Payer: PHCS Commercial |
$9,478.55
|
| Rate for Payer: United Healthcare All Payer |
$8,688.67
|
|
|
VEEG EA 12-26HR CONT MNTR
|
Professional
|
Both
|
$3,815.00
|
|
|
Service Code
|
HCPCS 95720
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$162.69 |
| Max. Negotiated Rate |
$2,289.00 |
| Rate for Payer: Ambetter Exchange |
$192.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.69
|
| Rate for Payer: Anthem Medicaid |
$167.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$192.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$192.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$230.46
|
| Rate for Payer: Cash Price |
$1,907.50
|
| Rate for Payer: Cash Price |
$1,907.50
|
| Rate for Payer: Humana Medicaid |
$167.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$250.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$192.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.97
|
| Rate for Payer: Molina Healthcare Passport |
$167.62
|
| Rate for Payer: Multiplan PHCS |
$2,289.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$249.66
|
| Rate for Payer: UHCCP Medicaid |
$170.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$192.05
|
|
|
VEEG EA 12-26HR CONT MNTR
|
Facility
|
OP
|
$3,815.00
|
|
|
Service Code
|
HCPCS 95716
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$940.05 |
| Max. Negotiated Rate |
$3,662.40 |
| Rate for Payer: Aetna Commercial |
$2,937.55
|
| Rate for Payer: Anthem Medicaid |
$1,311.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$940.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,975.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,316.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,269.07
|
| Rate for Payer: Cash Price |
$1,907.50
|
| Rate for Payer: Cash Price |
$1,907.50
|
| Rate for Payer: Cigna Commercial |
$3,166.45
|
| Rate for Payer: First Health Commercial |
$3,624.25
|
| Rate for Payer: Humana Commercial |
$3,242.75
|
| Rate for Payer: Humana KY Medicaid |
$1,311.98
|
| Rate for Payer: Humana Medicare Advantage |
$940.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,325.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,128.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,815.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,338.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,357.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,861.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,052.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,319.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,632.35
|
| Rate for Payer: PHCS Commercial |
$3,662.40
|
| Rate for Payer: United Healthcare All Payer |
$3,357.20
|
|
|
VEEG EA 12-26HR CONT MNTR
|
Facility
|
IP
|
$3,815.00
|
|
|
Service Code
|
HCPCS 95716
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,144.50 |
| Max. Negotiated Rate |
$3,662.40 |
| Rate for Payer: Aetna Commercial |
$2,937.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,975.70
|
| Rate for Payer: Cash Price |
$1,907.50
|
| Rate for Payer: Cigna Commercial |
$3,166.45
|
| Rate for Payer: First Health Commercial |
$3,624.25
|
| Rate for Payer: Humana Commercial |
$3,242.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,128.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,815.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,357.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,861.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,052.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,319.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,632.35
|
| Rate for Payer: PHCS Commercial |
$3,662.40
|
| Rate for Payer: United Healthcare All Payer |
$3,357.20
|
|
|
VEEG EA 12-26HR CONT MNTR (P
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 95720
|
| Hospital Charge Code |
740P0014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$250.75 |
| Rate for Payer: Ambetter Exchange |
$192.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.69
|
| Rate for Payer: Anthem Medicaid |
$167.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$192.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$192.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$230.46
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Humana Medicaid |
$167.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$250.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$192.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.97
|
| Rate for Payer: Molina Healthcare Passport |
$167.62
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$249.66
|
| Rate for Payer: UHCCP Medicaid |
$170.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$192.05
|
|
|
VEEG EA 12-26HR CONT MNTR (T
|
Facility
|
OP
|
$3,585.00
|
|
|
Service Code
|
HCPCS 95716
|
| Hospital Charge Code |
740T0014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$940.05 |
| Max. Negotiated Rate |
$3,441.60 |
| Rate for Payer: Aetna Commercial |
$2,760.45
|
| Rate for Payer: Anthem Medicaid |
$1,232.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$940.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,796.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,316.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,269.07
|
| Rate for Payer: Cash Price |
$1,792.50
|
| Rate for Payer: Cash Price |
$1,792.50
|
| Rate for Payer: Cigna Commercial |
$2,975.55
|
| Rate for Payer: First Health Commercial |
$3,405.75
|
| Rate for Payer: Humana Commercial |
$3,047.25
|
| Rate for Payer: Humana KY Medicaid |
$1,232.88
|
| Rate for Payer: Humana Medicare Advantage |
$940.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,245.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,939.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,645.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,257.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,154.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,688.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,868.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,118.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,473.65
|
| Rate for Payer: PHCS Commercial |
$3,441.60
|
| Rate for Payer: United Healthcare All Payer |
$3,154.80
|
|
|
VEEG EA 12-26HR CONT MNTR (T
|
Facility
|
IP
|
$3,585.00
|
|
|
Service Code
|
HCPCS 95716
|
| Hospital Charge Code |
740T0014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,075.50 |
| Max. Negotiated Rate |
$3,441.60 |
| Rate for Payer: Aetna Commercial |
$2,760.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,796.30
|
| Rate for Payer: Cash Price |
$1,792.50
|
| Rate for Payer: Cigna Commercial |
$2,975.55
|
| Rate for Payer: First Health Commercial |
$3,405.75
|
| Rate for Payer: Humana Commercial |
$3,047.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,939.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,645.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,075.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,154.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,688.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,868.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,118.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,473.65
|
| Rate for Payer: PHCS Commercial |
$3,441.60
|
| Rate for Payer: United Healthcare All Payer |
$3,154.80
|
|
|
VEGA AS FEM COMP SZ 4R NX030Z
|
Facility
|
OP
|
$21,823.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,546.98 |
| Max. Negotiated Rate |
$20,950.32 |
| Rate for Payer: Aetna Commercial |
$16,803.90
|
| Rate for Payer: Anthem Medicaid |
$7,505.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,022.13
|
| Rate for Payer: Cash Price |
$10,911.62
|
| Rate for Payer: Cigna Commercial |
$18,113.30
|
| Rate for Payer: First Health Commercial |
$20,732.09
|
| Rate for Payer: Humana Commercial |
$18,549.76
|
| Rate for Payer: Humana KY Medicaid |
$7,505.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,581.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,895.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,105.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,546.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,655.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,204.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,367.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,458.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,986.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,058.04
|
| Rate for Payer: PHCS Commercial |
$20,950.32
|
| Rate for Payer: United Healthcare All Payer |
$19,204.46
|
|
|
VEGA AS FEM COMP SZ 4R NX030Z
|
Facility
|
IP
|
$21,823.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,546.98 |
| Max. Negotiated Rate |
$20,950.32 |
| Rate for Payer: Aetna Commercial |
$16,803.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,022.13
|
| Rate for Payer: Cash Price |
$10,911.62
|
| Rate for Payer: Cigna Commercial |
$18,113.30
|
| Rate for Payer: First Health Commercial |
$20,732.09
|
| Rate for Payer: Humana Commercial |
$18,549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,895.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,105.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,546.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,204.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,367.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,458.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,986.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,058.04
|
| Rate for Payer: PHCS Commercial |
$20,950.32
|
| Rate for Payer: United Healthcare All Payer |
$19,204.46
|
|
|
VEGA AS FEMUR COMP SZ 4 L
|
Facility
|
OP
|
$15,790.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.25 |
| Max. Negotiated Rate |
$15,159.19 |
| Rate for Payer: Aetna Commercial |
$12,158.93
|
| Rate for Payer: Anthem Medicaid |
$5,430.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.84
|
| Rate for Payer: Cash Price |
$7,895.41
|
| Rate for Payer: Cigna Commercial |
$13,106.38
|
| Rate for Payer: First Health Commercial |
$15,001.28
|
| Rate for Payer: Humana Commercial |
$13,422.20
|
| Rate for Payer: Humana KY Medicaid |
$5,430.46
|
| Rate for Payer: Kentucky WC Medicaid |
$5,485.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,948.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,539.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.92
|
| Rate for Payer: Ohio Health Group HMO |
$11,843.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,738.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.67
|
| Rate for Payer: PHCS Commercial |
$15,159.19
|
| Rate for Payer: United Healthcare All Payer |
$13,895.92
|
|
|
VEGA AS FEMUR COMP SZ 4 L
|
Facility
|
IP
|
$15,790.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.25 |
| Max. Negotiated Rate |
$15,159.19 |
| Rate for Payer: Aetna Commercial |
$12,158.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.84
|
| Rate for Payer: Cash Price |
$7,895.41
|
| Rate for Payer: Cigna Commercial |
$13,106.38
|
| Rate for Payer: First Health Commercial |
$15,001.28
|
| Rate for Payer: Humana Commercial |
$13,422.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,948.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.92
|
| Rate for Payer: Ohio Health Group HMO |
$11,843.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,738.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.67
|
| Rate for Payer: PHCS Commercial |
$15,159.19
|
| Rate for Payer: United Healthcare All Payer |
$13,895.92
|
|
|
VEGA AS PS FEM COMP CEM F5R
|
Facility
|
OP
|
$21,823.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,546.98 |
| Max. Negotiated Rate |
$20,950.32 |
| Rate for Payer: Aetna Commercial |
$16,803.90
|
| Rate for Payer: Anthem Medicaid |
$7,505.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,022.13
|
| Rate for Payer: Cash Price |
$10,911.62
|
| Rate for Payer: Cigna Commercial |
$18,113.30
|
| Rate for Payer: First Health Commercial |
$20,732.09
|
| Rate for Payer: Humana Commercial |
$18,549.76
|
| Rate for Payer: Humana KY Medicaid |
$7,505.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,581.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,895.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,105.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,546.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,655.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,204.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,367.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,458.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,986.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,058.04
|
| Rate for Payer: PHCS Commercial |
$20,950.32
|
| Rate for Payer: United Healthcare All Payer |
$19,204.46
|
|
|
VEGA AS PS FEM COMP CEM F5R
|
Facility
|
IP
|
$21,823.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,546.98 |
| Max. Negotiated Rate |
$20,950.32 |
| Rate for Payer: Aetna Commercial |
$16,803.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,022.13
|
| Rate for Payer: Cash Price |
$10,911.62
|
| Rate for Payer: Cigna Commercial |
$18,113.30
|
| Rate for Payer: First Health Commercial |
$20,732.09
|
| Rate for Payer: Humana Commercial |
$18,549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,895.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,105.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,546.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,204.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,367.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,458.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,986.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,058.04
|
| Rate for Payer: PHCS Commercial |
$20,950.32
|
| Rate for Payer: United Healthcare All Payer |
$19,204.46
|
|
|
VEGA AS PS TIB PLAT CEM T3
|
Facility
|
OP
|
$24,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,350.00 |
| Max. Negotiated Rate |
$23,520.00 |
| Rate for Payer: Aetna Commercial |
$18,865.00
|
| Rate for Payer: Anthem Medicaid |
$8,425.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,110.00
|
| Rate for Payer: Cash Price |
$12,250.00
|
| Rate for Payer: Cigna Commercial |
$20,335.00
|
| Rate for Payer: First Health Commercial |
$23,275.00
|
| Rate for Payer: Humana Commercial |
$20,825.00
|
| Rate for Payer: Humana KY Medicaid |
$8,425.55
|
| Rate for Payer: Kentucky WC Medicaid |
$8,511.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,090.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,081.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,350.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,594.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,560.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,315.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,905.00
|
| Rate for Payer: PHCS Commercial |
$23,520.00
|
| Rate for Payer: United Healthcare All Payer |
$21,560.00
|
|
|
VEGA AS PS TIB PLAT CEM T3
|
Facility
|
IP
|
$24,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,350.00 |
| Max. Negotiated Rate |
$23,520.00 |
| Rate for Payer: Aetna Commercial |
$18,865.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,110.00
|
| Rate for Payer: Cash Price |
$12,250.00
|
| Rate for Payer: Cigna Commercial |
$20,335.00
|
| Rate for Payer: First Health Commercial |
$23,275.00
|
| Rate for Payer: Humana Commercial |
$20,825.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,090.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,081.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,350.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,560.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,315.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,905.00
|
| Rate for Payer: PHCS Commercial |
$23,520.00
|
| Rate for Payer: United Healthcare All Payer |
$21,560.00
|
|
|
VEGA AS TIB EXT STEM 12*52MM
|
Facility
|
IP
|
$8,724.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.23 |
| Max. Negotiated Rate |
$8,375.15 |
| Rate for Payer: Aetna Commercial |
$6,717.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,804.81
|
| Rate for Payer: Cash Price |
$4,362.06
|
| Rate for Payer: Cigna Commercial |
$7,241.01
|
| Rate for Payer: First Health Commercial |
$8,287.90
|
| Rate for Payer: Humana Commercial |
$7,415.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,153.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,438.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,677.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,543.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,979.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,589.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,019.64
|
| Rate for Payer: PHCS Commercial |
$8,375.15
|
| Rate for Payer: United Healthcare All Payer |
$7,677.22
|
|
|
VEGA AS TIB EXT STEM 12*52MM
|
Facility
|
OP
|
$8,724.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.23 |
| Max. Negotiated Rate |
$8,375.15 |
| Rate for Payer: Aetna Commercial |
$6,717.56
|
| Rate for Payer: Anthem Medicaid |
$3,000.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,804.81
|
| Rate for Payer: Cash Price |
$4,362.06
|
| Rate for Payer: Cigna Commercial |
$7,241.01
|
| Rate for Payer: First Health Commercial |
$8,287.90
|
| Rate for Payer: Humana Commercial |
$7,415.49
|
| Rate for Payer: Humana KY Medicaid |
$3,000.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,030.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,153.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,438.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,060.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,677.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,543.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,979.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,589.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,019.64
|
| Rate for Payer: PHCS Commercial |
$8,375.15
|
| Rate for Payer: United Healthcare All Payer |
$7,677.22
|
|
|
VEGA FEMUR SZ F5N L66.5*8
|
Facility
|
OP
|
$15,790.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.25 |
| Max. Negotiated Rate |
$15,159.19 |
| Rate for Payer: Aetna Commercial |
$12,158.93
|
| Rate for Payer: Anthem Medicaid |
$5,430.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.84
|
| Rate for Payer: Cash Price |
$7,895.41
|
| Rate for Payer: Cigna Commercial |
$13,106.38
|
| Rate for Payer: First Health Commercial |
$15,001.28
|
| Rate for Payer: Humana Commercial |
$13,422.20
|
| Rate for Payer: Humana KY Medicaid |
$5,430.46
|
| Rate for Payer: Kentucky WC Medicaid |
$5,485.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,948.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,539.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.92
|
| Rate for Payer: Ohio Health Group HMO |
$11,843.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,738.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.67
|
| Rate for Payer: PHCS Commercial |
$15,159.19
|
| Rate for Payer: United Healthcare All Payer |
$13,895.92
|
|
|
VEGA FEMUR SZ F5N L66.5*8
|
Facility
|
IP
|
$15,790.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,737.25 |
| Max. Negotiated Rate |
$15,159.19 |
| Rate for Payer: Aetna Commercial |
$12,158.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,316.84
|
| Rate for Payer: Cash Price |
$7,895.41
|
| Rate for Payer: Cigna Commercial |
$13,106.38
|
| Rate for Payer: First Health Commercial |
$15,001.28
|
| Rate for Payer: Humana Commercial |
$13,422.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,948.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,653.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,737.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,895.92
|
| Rate for Payer: Ohio Health Group HMO |
$11,843.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,632.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,738.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,895.67
|
| Rate for Payer: PHCS Commercial |
$15,159.19
|
| Rate for Payer: United Healthcare All Payer |
$13,895.92
|
|
|
VEGA PATELLA 3 PEGS P3
|
Facility
|
OP
|
$4,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.90 |
| Max. Negotiated Rate |
$4,486.08 |
| Rate for Payer: Aetna Commercial |
$3,598.21
|
| Rate for Payer: Anthem Medicaid |
$1,607.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,644.94
|
| Rate for Payer: Cash Price |
$2,336.50
|
| Rate for Payer: Cigna Commercial |
$3,878.59
|
| Rate for Payer: First Health Commercial |
$4,439.35
|
| Rate for Payer: Humana Commercial |
$3,972.05
|
| Rate for Payer: Humana KY Medicaid |
$1,607.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,831.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,448.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,401.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.37
|
| Rate for Payer: PHCS Commercial |
$4,486.08
|
| Rate for Payer: United Healthcare All Payer |
$4,112.24
|
|
|
VEGA PATELLA 3 PEGS P3
|
Facility
|
IP
|
$4,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.90 |
| Max. Negotiated Rate |
$4,486.08 |
| Rate for Payer: Aetna Commercial |
$3,598.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,644.94
|
| Rate for Payer: Cash Price |
$2,336.50
|
| Rate for Payer: Cigna Commercial |
$3,878.59
|
| Rate for Payer: First Health Commercial |
$4,439.35
|
| Rate for Payer: Humana Commercial |
$3,972.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,831.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,448.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,401.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.37
|
| Rate for Payer: PHCS Commercial |
$4,486.08
|
| Rate for Payer: United Healthcare All Payer |
$4,112.24
|
|
|
VEGA PS GLIDING SURF T3/T3+ 10
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
VEGA PS GLIDING SURF T3/T3+ 10
|
Facility
|
IP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
|
VEGA PS GLIDING SURF T3/T3+ 12
|
Facility
|
OP
|
$9,620.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,886.11 |
| Max. Negotiated Rate |
$9,235.56 |
| Rate for Payer: Aetna Commercial |
$7,407.68
|
| Rate for Payer: Anthem Medicaid |
$3,308.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,503.89
|
| Rate for Payer: Cash Price |
$4,810.19
|
| Rate for Payer: Cigna Commercial |
$7,984.91
|
| Rate for Payer: First Health Commercial |
$9,139.35
|
| Rate for Payer: Humana Commercial |
$8,177.31
|
| Rate for Payer: Humana KY Medicaid |
$3,308.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,888.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,099.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,374.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,465.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,696.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,369.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,638.06
|
| Rate for Payer: PHCS Commercial |
$9,235.56
|
| Rate for Payer: United Healthcare All Payer |
$8,465.93
|
|
