|
UTERINE MANIPULATOR/INJECTOR
|
Facility
|
OP
|
$3,523.74
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$458.09 |
| Max. Negotiated Rate |
$3,382.79 |
| Rate for Payer: Aetna Commercial |
$2,713.28
|
| Rate for Payer: Anthem Medicaid |
$1,211.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,748.52
|
| Rate for Payer: Cash Price |
$1,761.87
|
| Rate for Payer: Cigna Commercial |
$2,924.70
|
| Rate for Payer: First Health Commercial |
$3,347.55
|
| Rate for Payer: Humana Commercial |
$2,995.18
|
| Rate for Payer: Humana KY Medicaid |
$1,211.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,224.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,889.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,600.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,057.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,236.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,100.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,642.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,092.36
|
| Rate for Payer: PHCS Commercial |
$3,382.79
|
| Rate for Payer: United Healthcare All Payer |
$3,100.89
|
|
|
V40SLEVE 4MM TAPER 5X40
|
Facility
|
IP
|
$1,982.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.76 |
| Max. Negotiated Rate |
$1,903.49 |
| Rate for Payer: Aetna Commercial |
$1,526.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,546.58
|
| Rate for Payer: Cash Price |
$991.40
|
| Rate for Payer: Cigna Commercial |
$1,645.72
|
| Rate for Payer: First Health Commercial |
$1,883.66
|
| Rate for Payer: Humana Commercial |
$1,685.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,625.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,463.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,744.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,487.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.67
|
| Rate for Payer: PHCS Commercial |
$1,903.49
|
| Rate for Payer: United Healthcare All Payer |
$1,744.86
|
|
|
V40SLEVE 4MM TAPER 5X40
|
Facility
|
OP
|
$1,982.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.76 |
| Max. Negotiated Rate |
$1,903.49 |
| Rate for Payer: Aetna Commercial |
$1,526.76
|
| Rate for Payer: Anthem Medicaid |
$681.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,546.58
|
| Rate for Payer: Cash Price |
$991.40
|
| Rate for Payer: Cigna Commercial |
$1,645.72
|
| Rate for Payer: First Health Commercial |
$1,883.66
|
| Rate for Payer: Humana Commercial |
$1,685.38
|
| Rate for Payer: Humana KY Medicaid |
$681.88
|
| Rate for Payer: Kentucky WC Medicaid |
$688.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,625.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,463.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,744.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,487.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.67
|
| Rate for Payer: PHCS Commercial |
$1,903.49
|
| Rate for Payer: United Healthcare All Payer |
$1,744.86
|
|
|
VAC ADM UNDER 18, PER 1ST ONLY
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
77000061
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem Medicaid |
$28.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.74
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Humana KY Medicaid |
$28.54
|
| Rate for Payer: Kentucky WC Medicaid |
$28.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.73
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
VAC ADM UNDER 18, PER 1ST ONLY
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
77000061
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.74
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.73
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
VAC ADM UNDER 18, PER 1ST ONLY
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
770T0061
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem Medicaid |
$28.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.74
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Humana KY Medicaid |
$28.54
|
| Rate for Payer: Kentucky WC Medicaid |
$28.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.73
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
VAC ADM UNDER 18, PER 1ST ONLY
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
77000061
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$83.00
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$33.19
|
| Rate for Payer: Healthspan PPO |
$20.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.58
|
| Rate for Payer: Multiplan PHCS |
$49.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$58.10
|
| Rate for Payer: UHCCP Medicaid |
$29.05
|
| Rate for Payer: United Healthcare Non-Options |
$25.67
|
| Rate for Payer: United Healthcare Options |
$21.02
|
|
|
VAC ADM UNDER 18, PER 1ST ONLY
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
770T0061
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$79.68 |
| Rate for Payer: Aetna Commercial |
$63.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.74
|
| Rate for Payer: Cash Price |
$41.50
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: First Health Commercial |
$78.85
|
| Rate for Payer: Humana Commercial |
$70.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.04
|
| Rate for Payer: Ohio Health Group HMO |
$62.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.73
|
| Rate for Payer: PHCS Commercial |
$79.68
|
| Rate for Payer: United Healthcare All Payer |
$73.04
|
|
|
VAC VIA 7 DAY THERAPY SYS KIT
|
Facility
|
IP
|
$4,734.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.42 |
| Max. Negotiated Rate |
$4,544.64 |
| Rate for Payer: Aetna Commercial |
$3,645.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,692.52
|
| Rate for Payer: Cash Price |
$2,367.00
|
| Rate for Payer: Cigna Commercial |
$3,929.22
|
| Rate for Payer: First Health Commercial |
$4,497.30
|
| Rate for Payer: Humana Commercial |
$4,023.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,881.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,493.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,165.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,550.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.54
|
| Rate for Payer: PHCS Commercial |
$4,544.64
|
| Rate for Payer: United Healthcare All Payer |
$4,165.92
|
|
|
VAC VIA 7 DAY THERAPY SYS KIT
|
Facility
|
OP
|
$4,734.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.42 |
| Max. Negotiated Rate |
$4,544.64 |
| Rate for Payer: Aetna Commercial |
$3,645.18
|
| Rate for Payer: Anthem Medicaid |
$1,628.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,692.52
|
| Rate for Payer: Cash Price |
$2,367.00
|
| Rate for Payer: Cigna Commercial |
$3,929.22
|
| Rate for Payer: First Health Commercial |
$4,497.30
|
| Rate for Payer: Humana Commercial |
$4,023.90
|
| Rate for Payer: Humana KY Medicaid |
$1,628.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,644.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,881.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,493.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,660.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,165.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,550.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.54
|
| Rate for Payer: PHCS Commercial |
$4,544.64
|
| Rate for Payer: United Healthcare All Payer |
$4,165.92
|
|
|
VAG DELIVERY ONLY
|
Professional
|
Both
|
$6,653.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
72000016
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$6,653.00 |
| Rate for Payer: Aetna Commercial |
$1,298.78
|
| Rate for Payer: Anthem Medicaid |
$870.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,653.00
|
| Rate for Payer: Cash Price |
$3,326.50
|
| Rate for Payer: Cash Price |
$3,326.50
|
| Rate for Payer: Cigna Commercial |
$1,199.30
|
| Rate for Payer: Healthspan PPO |
$1,050.00
|
| Rate for Payer: Humana Medicaid |
$870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,361.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$887.40
|
| Rate for Payer: Molina Healthcare Passport |
$870.00
|
| Rate for Payer: Multiplan PHCS |
$3,991.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,657.10
|
| Rate for Payer: UHCCP Medicaid |
$2,328.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$878.70
|
|
|
VAG DELIVERY ONLY
|
Facility
|
OP
|
$6,653.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
72000016
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$864.89 |
| Max. Negotiated Rate |
$6,386.88 |
| Rate for Payer: Aetna Commercial |
$5,122.81
|
| Rate for Payer: Anthem Medicaid |
$2,287.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,189.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$3,326.50
|
| Rate for Payer: Cash Price |
$3,326.50
|
| Rate for Payer: Cigna Commercial |
$5,521.99
|
| Rate for Payer: First Health Commercial |
$6,320.35
|
| Rate for Payer: Humana Commercial |
$5,655.05
|
| Rate for Payer: Humana KY Medicaid |
$2,287.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,311.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,455.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,909.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,333.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,854.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,989.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,330.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$864.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,062.43
|
| Rate for Payer: PHCS Commercial |
$6,386.88
|
| Rate for Payer: United Healthcare All Payer |
$5,854.64
|
|
|
VAG DELIVERY ONLY
|
Facility
|
IP
|
$6,653.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
72000016
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$864.89 |
| Max. Negotiated Rate |
$6,386.88 |
| Rate for Payer: Aetna Commercial |
$5,122.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,189.34
|
| Rate for Payer: Cash Price |
$3,326.50
|
| Rate for Payer: Cigna Commercial |
$5,521.99
|
| Rate for Payer: First Health Commercial |
$6,320.35
|
| Rate for Payer: Humana Commercial |
$5,655.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,455.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,909.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,854.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,989.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,330.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$864.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,062.43
|
| Rate for Payer: PHCS Commercial |
$6,386.88
|
| Rate for Payer: United Healthcare All Payer |
$5,854.64
|
|
|
VAG DELIVERY ONLY(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
720P0016
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$1,298.78
|
| Rate for Payer: Anthem Medicaid |
$870.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,199.30
|
| Rate for Payer: Healthspan PPO |
$1,050.00
|
| Rate for Payer: Humana Medicaid |
$870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,361.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$887.40
|
| Rate for Payer: Molina Healthcare Passport |
$870.00
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$878.70
|
|
|
VAG DELIVERY ONLY(T
|
Facility
|
IP
|
$4,953.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
720T0016
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$643.89 |
| Max. Negotiated Rate |
$4,754.88 |
| Rate for Payer: Aetna Commercial |
$3,813.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,863.34
|
| Rate for Payer: Cash Price |
$2,476.50
|
| Rate for Payer: Cigna Commercial |
$4,110.99
|
| Rate for Payer: First Health Commercial |
$4,705.35
|
| Rate for Payer: Humana Commercial |
$4,210.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,061.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,655.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,485.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,358.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,714.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$990.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,535.43
|
| Rate for Payer: PHCS Commercial |
$4,754.88
|
| Rate for Payer: United Healthcare All Payer |
$4,358.64
|
|
|
VAG DELIVERY ONLY(T
|
Facility
|
OP
|
$4,953.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
720T0016
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$643.89 |
| Max. Negotiated Rate |
$4,754.88 |
| Rate for Payer: Aetna Commercial |
$3,813.81
|
| Rate for Payer: Anthem Medicaid |
$1,703.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,863.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,476.50
|
| Rate for Payer: Cash Price |
$2,476.50
|
| Rate for Payer: Cigna Commercial |
$4,110.99
|
| Rate for Payer: First Health Commercial |
$4,705.35
|
| Rate for Payer: Humana Commercial |
$4,210.05
|
| Rate for Payer: Humana KY Medicaid |
$1,703.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,720.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,061.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,655.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,737.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,358.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,714.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$990.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,535.43
|
| Rate for Payer: PHCS Commercial |
$4,754.88
|
| Rate for Payer: United Healthcare All Payer |
$4,358.64
|
|
|
VAG DELIVERY ONLY W/POST CARE
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 59410
|
| Hospital Charge Code |
72000017
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
VAG DELIVERY ONLY W/POST CARE
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 59410
|
| Hospital Charge Code |
72000017
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
VAG DELIVERY ONLY W/POST CARE
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 59410
|
| Hospital Charge Code |
72000017
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,498.35
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,374.92
|
| Rate for Payer: Healthspan PPO |
$1,180.00
|
| Rate for Payer: Humana Medicaid |
$900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,519.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.00
|
| Rate for Payer: Molina Healthcare Passport |
$900.00
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
|
|
VAG DELIVERY ONLY W/POST CAR(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 59410
|
| Hospital Charge Code |
720P0017
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,498.35
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,374.92
|
| Rate for Payer: Healthspan PPO |
$1,180.00
|
| Rate for Payer: Humana Medicaid |
$900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,519.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.00
|
| Rate for Payer: Molina Healthcare Passport |
$900.00
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
|
|
VAG HYST
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58260
|
| Hospital Charge Code |
76102214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VAG HYST
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58260
|
| Hospital Charge Code |
76102214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VAG HYST
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58260
|
| Hospital Charge Code |
76102214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.38 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,252.96
|
| Rate for Payer: Anthem Medicaid |
$636.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,220.74
|
| Rate for Payer: Healthspan PPO |
$1,213.18
|
| Rate for Payer: Humana Medicaid |
$636.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,075.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$649.11
|
| Rate for Payer: Molina Healthcare Passport |
$636.38
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$642.74
|
|
|
VAG HYST(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58260
|
| Hospital Charge Code |
761P2214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.38 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,252.96
|
| Rate for Payer: Anthem Medicaid |
$636.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,220.74
|
| Rate for Payer: Healthspan PPO |
$1,213.18
|
| Rate for Payer: Humana Medicaid |
$636.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,075.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$649.11
|
| Rate for Payer: Molina Healthcare Passport |
$636.38
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$642.74
|
|
|
VAG HYST W/ANTERIOR REPAIR
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58267
|
| Hospital Charge Code |
76102216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$778.08 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,605.99
|
| Rate for Payer: Anthem Medicaid |
$778.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,568.22
|
| Rate for Payer: Healthspan PPO |
$1,555.01
|
| Rate for Payer: Humana Medicaid |
$778.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,375.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$793.64
|
| Rate for Payer: Molina Healthcare Passport |
$778.08
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$785.86
|
|
