|
VASCULAR SHEATH 6FR FLEXOR
|
Facility
|
IP
|
$1,155.52
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.22 |
| Max. Negotiated Rate |
$1,109.30 |
| Rate for Payer: Aetna Commercial |
$889.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.31
|
| Rate for Payer: Cash Price |
$577.76
|
| Rate for Payer: Cigna Commercial |
$959.08
|
| Rate for Payer: First Health Commercial |
$1,097.74
|
| Rate for Payer: Humana Commercial |
$982.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.86
|
| Rate for Payer: Ohio Health Group HMO |
$866.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.21
|
| Rate for Payer: PHCS Commercial |
$1,109.30
|
| Rate for Payer: United Healthcare All Payer |
$1,016.86
|
|
|
VASCULAR SHEATH 7FR FLEXOR
|
Facility
|
IP
|
$1,155.52
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.22 |
| Max. Negotiated Rate |
$1,109.30 |
| Rate for Payer: Aetna Commercial |
$889.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.31
|
| Rate for Payer: Cash Price |
$577.76
|
| Rate for Payer: Cigna Commercial |
$959.08
|
| Rate for Payer: First Health Commercial |
$1,097.74
|
| Rate for Payer: Humana Commercial |
$982.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.86
|
| Rate for Payer: Ohio Health Group HMO |
$866.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.21
|
| Rate for Payer: PHCS Commercial |
$1,109.30
|
| Rate for Payer: United Healthcare All Payer |
$1,016.86
|
|
|
VASCULAR SHEATH 7FR FLEXOR
|
Facility
|
OP
|
$1,155.52
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.22 |
| Max. Negotiated Rate |
$1,109.30 |
| Rate for Payer: Aetna Commercial |
$889.75
|
| Rate for Payer: Anthem Medicaid |
$397.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.31
|
| Rate for Payer: Cash Price |
$577.76
|
| Rate for Payer: Cigna Commercial |
$959.08
|
| Rate for Payer: First Health Commercial |
$1,097.74
|
| Rate for Payer: Humana Commercial |
$982.19
|
| Rate for Payer: Humana KY Medicaid |
$397.38
|
| Rate for Payer: Kentucky WC Medicaid |
$401.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.86
|
| Rate for Payer: Ohio Health Group HMO |
$866.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.21
|
| Rate for Payer: PHCS Commercial |
$1,109.30
|
| Rate for Payer: United Healthcare All Payer |
$1,016.86
|
|
|
VASC VEIN MAP DIALYSIS ACCESS
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
VASC VEIN MAP DIALYSIS ACCESS
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Anthem Medicaid |
$197.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Humana Medicaid |
$197.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.74
|
| Rate for Payer: Molina Healthcare Passport |
$197.78
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.76
|
|
|
VASC VEIN MAP DIALYSIS ACCESS
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
92100025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
VASC VEINMAP DIALYSIS ACCESS(P
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
921P0025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Anthem Medicaid |
$197.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$240.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Humana Medicaid |
$197.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.74
|
| Rate for Payer: Molina Healthcare Passport |
$197.78
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.00
|
| Rate for Payer: UHCCP Medicaid |
$84.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.76
|
|
|
VASC VEINMAP DIALYSIS ACCESS(T
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
921T0025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem Medicaid |
$192.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Humana KY Medicaid |
$192.58
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$194.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
VASC VEINMAP DIALYSIS ACCESS(T
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
921T0025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
VASECTOMY IN OFFICE SP
|
Professional
|
Both
|
$550.00
|
|
| Hospital Charge Code |
22200717
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)
|
Facility
|
OP
|
$2,465.88
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,761.34 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
|
|
VASELINE(PETROLATUM) OINT 5GM
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 84521000686
|
| Hospital Charge Code |
27000219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna Commercial |
$0.22
|
| Rate for Payer: First Health Commercial |
$0.26
|
| Rate for Payer: Humana Commercial |
$0.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.24
|
| Rate for Payer: Ohio Health Group HMO |
$0.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.08
|
| Rate for Payer: PHCS Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Payer |
$0.24
|
|
|
VASELINE(PETROLATUM) OINT 5GM
|
Facility
|
IP
|
$3.85
|
|
| Hospital Charge Code |
27000219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.00
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna Commercial |
$3.20
|
| Rate for Payer: First Health Commercial |
$3.66
|
| Rate for Payer: Humana Commercial |
$3.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.39
|
| Rate for Payer: Ohio Health Group HMO |
$2.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.19
|
| Rate for Payer: PHCS Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Payer |
$3.39
|
|
|
VASELINE(PETROLATUM) OINT 5GM
|
Facility
|
OP
|
$3.85
|
|
| Hospital Charge Code |
27000219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Anthem Medicaid |
$1.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.00
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna Commercial |
$3.20
|
| Rate for Payer: First Health Commercial |
$3.66
|
| Rate for Payer: Humana Commercial |
$3.27
|
| Rate for Payer: Humana KY Medicaid |
$1.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.39
|
| Rate for Payer: Ohio Health Group HMO |
$2.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.19
|
| Rate for Payer: PHCS Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Payer |
$3.39
|
|
|
VASELINE(PETROLATUM) OINT 5GM
|
Professional
|
Both
|
$3.85
|
|
| Hospital Charge Code |
27000219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Buckeye Medicare Advantage |
$3.85
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Multiplan PHCS |
$2.31
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.70
|
| Rate for Payer: UHCCP Medicaid |
$1.35
|
|
|
VASELINE(PETROLATUM) OINT 5GM
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 84521000686
|
| Hospital Charge Code |
27000219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Anthem Medicaid |
$0.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna Commercial |
$0.22
|
| Rate for Payer: First Health Commercial |
$0.26
|
| Rate for Payer: Humana Commercial |
$0.23
|
| Rate for Payer: Humana KY Medicaid |
$0.09
|
| Rate for Payer: Kentucky WC Medicaid |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.24
|
| Rate for Payer: Ohio Health Group HMO |
$0.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.08
|
| Rate for Payer: PHCS Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Payer |
$0.24
|
|
|
VASOPNEUMATIC DEV INTERM/SEQ
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 97016
|
| Hospital Charge Code |
42000008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$138.24 |
| Rate for Payer: Aetna Commercial |
$110.88
|
| Rate for Payer: Anthem Medicaid |
$49.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.32
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$119.52
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: Humana Commercial |
$122.40
|
| Rate for Payer: Humana KY Medicaid |
$49.52
|
| Rate for Payer: Kentucky WC Medicaid |
$50.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$126.72
|
| Rate for Payer: Ohio Health Group HMO |
$108.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.64
|
| Rate for Payer: PHCS Commercial |
$138.24
|
| Rate for Payer: United Healthcare All Payer |
$126.72
|
|
|
VASOPNEUMATIC DEV INTERM/SEQ
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 97016
|
| Hospital Charge Code |
42000008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$138.24 |
| Rate for Payer: Aetna Commercial |
$110.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.32
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$119.52
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: Humana Commercial |
$122.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$126.72
|
| Rate for Payer: Ohio Health Group HMO |
$108.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.64
|
| Rate for Payer: PHCS Commercial |
$138.24
|
| Rate for Payer: United Healthcare All Payer |
$126.72
|
|
|
VASOPNEUMATIC DEV INTERM/SEQUE
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 97016
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$138.24 |
| Rate for Payer: Aetna Commercial |
$110.88
|
| Rate for Payer: Anthem Medicaid |
$49.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.32
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$119.52
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: Humana Commercial |
$122.40
|
| Rate for Payer: Humana KY Medicaid |
$49.52
|
| Rate for Payer: Kentucky WC Medicaid |
$50.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$126.72
|
| Rate for Payer: Ohio Health Group HMO |
$108.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.64
|
| Rate for Payer: PHCS Commercial |
$138.24
|
| Rate for Payer: United Healthcare All Payer |
$126.72
|
|
|
VASOPNEUMATIC DEV INTERM/SEQUE
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 97016
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$138.24 |
| Rate for Payer: Aetna Commercial |
$110.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.32
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$119.52
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: Humana Commercial |
$122.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$126.72
|
| Rate for Payer: Ohio Health Group HMO |
$108.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.64
|
| Rate for Payer: PHCS Commercial |
$138.24
|
| Rate for Payer: United Healthcare All Payer |
$126.72
|
|
|
VASOPRESSI IN NS 100UN/100MLIV
|
Facility
|
IP
|
$102.10
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$98.02 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.64
|
| Rate for Payer: Cash Price |
$51.05
|
| Rate for Payer: Cigna Commercial |
$84.74
|
| Rate for Payer: First Health Commercial |
$97.00
|
| Rate for Payer: Humana Commercial |
$86.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.85
|
| Rate for Payer: Ohio Health Group HMO |
$76.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.65
|
| Rate for Payer: PHCS Commercial |
$98.02
|
| Rate for Payer: United Healthcare All Payer |
$89.85
|
|
|
VASOPRESSI IN NS 100UN/100MLIV
|
Facility
|
OP
|
$102.10
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$98.02 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Anthem Medicaid |
$35.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.64
|
| Rate for Payer: Cash Price |
$51.05
|
| Rate for Payer: Cigna Commercial |
$84.74
|
| Rate for Payer: First Health Commercial |
$97.00
|
| Rate for Payer: Humana Commercial |
$86.78
|
| Rate for Payer: Humana KY Medicaid |
$35.11
|
| Rate for Payer: Kentucky WC Medicaid |
$35.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.85
|
| Rate for Payer: Ohio Health Group HMO |
$76.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.65
|
| Rate for Payer: PHCS Commercial |
$98.02
|
| Rate for Payer: United Healthcare All Payer |
$89.85
|
|
|
VASOPRESSIN(GEN)1u(20uSDV)
|
Facility
|
IP
|
$119.06
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
25003357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.48 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna Commercial |
$91.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.87
|
| Rate for Payer: Cash Price |
$59.53
|
| Rate for Payer: Cigna Commercial |
$98.82
|
| Rate for Payer: First Health Commercial |
$113.11
|
| Rate for Payer: Humana Commercial |
$101.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.77
|
| Rate for Payer: Ohio Health Group HMO |
$89.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.91
|
| Rate for Payer: PHCS Commercial |
$114.30
|
| Rate for Payer: United Healthcare All Payer |
$104.77
|
|
|
VASOPRESSIN(GEN)1u(20uSDV)
|
Facility
|
OP
|
$119.06
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
25003357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Cash Price |
$59.53
|
| Rate for Payer: Cash Price |
$59.53
|
| Rate for Payer: Cigna Commercial |
$98.82
|
| Rate for Payer: First Health Commercial |
$113.11
|
| Rate for Payer: Humana Commercial |
$101.20
|
| Rate for Payer: Humana KY Medicaid |
$40.94
|
| Rate for Payer: Humana Medicare Advantage |
$1.82
|
| Rate for Payer: Kentucky WC Medicaid |
$41.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.77
|
| Rate for Payer: Ohio Health Group HMO |
$89.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.91
|
| Rate for Payer: PHCS Commercial |
$114.30
|
| Rate for Payer: United Healthcare All Payer |
$104.77
|
| Rate for Payer: Aetna Commercial |
$91.68
|
| Rate for Payer: Anthem Medicaid |
$40.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.45
|
|
|
VASOTEC 2.5 MG/2 ML VIAL
|
Facility
|
IP
|
$116.48
|
|
|
Service Code
|
NDC 143978610
|
| Hospital Charge Code |
25003564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$111.82 |
| Rate for Payer: Aetna Commercial |
$89.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.85
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cigna Commercial |
$96.68
|
| Rate for Payer: First Health Commercial |
$110.66
|
| Rate for Payer: Humana Commercial |
$99.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.50
|
| Rate for Payer: Ohio Health Group HMO |
$87.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.11
|
| Rate for Payer: PHCS Commercial |
$111.82
|
| Rate for Payer: United Healthcare All Payer |
$102.50
|
|
