|
VBAC CARE AFTER DELIVERY
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 59614
|
| Hospital Charge Code |
76102614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$1,677.53 |
| Rate for Payer: Aetna Commercial |
$1,623.34
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,380.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$1,497.28
|
| Rate for Payer: Healthspan PPO |
$1,178.25
|
| Rate for Payer: Humana Medicaid |
$900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,677.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.00
|
| Rate for Payer: Molina Healthcare Passport |
$900.00
|
| Rate for Payer: Multiplan PHCS |
$828.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$966.00
|
| Rate for Payer: UHCCP Medicaid |
$483.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
|
|
VBAC CARE AFTER DELIVERY
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
HCPCS 59614
|
| Hospital Charge Code |
76102614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Aetna Commercial |
$1,062.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,076.40
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: First Health Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial |
$1,173.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,131.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,018.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$414.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,214.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.80
|
| Rate for Payer: PHCS Commercial |
$1,324.80
|
| Rate for Payer: United Healthcare All Payer |
$1,214.40
|
|
|
VBAC DELIVERY ONLY
|
Facility
|
IP
|
$5,931.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
72000025
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$771.03 |
| Max. Negotiated Rate |
$5,693.76 |
| Rate for Payer: Aetna Commercial |
$4,566.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,626.18
|
| Rate for Payer: Cash Price |
$2,965.50
|
| Rate for Payer: Cigna Commercial |
$4,922.73
|
| Rate for Payer: First Health Commercial |
$5,634.45
|
| Rate for Payer: Humana Commercial |
$5,041.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,863.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,377.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,779.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,219.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,186.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$771.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,838.61
|
| Rate for Payer: PHCS Commercial |
$5,693.76
|
| Rate for Payer: United Healthcare All Payer |
$5,219.28
|
|
|
VBAC DELIVERY ONLY
|
Facility
|
OP
|
$5,931.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
72000025
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$771.03 |
| Max. Negotiated Rate |
$5,693.76 |
| Rate for Payer: Aetna Commercial |
$4,566.87
|
| Rate for Payer: Anthem Medicaid |
$2,039.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,626.18
|
| 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 |
$2,965.50
|
| Rate for Payer: Cash Price |
$2,965.50
|
| Rate for Payer: Cigna Commercial |
$4,922.73
|
| Rate for Payer: First Health Commercial |
$5,634.45
|
| Rate for Payer: Humana Commercial |
$5,041.35
|
| Rate for Payer: Humana KY Medicaid |
$2,039.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,060.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,863.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,377.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,080.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,219.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,186.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$771.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,838.61
|
| Rate for Payer: PHCS Commercial |
$5,693.76
|
| Rate for Payer: United Healthcare All Payer |
$5,219.28
|
|
|
VBAC DELIVERY ONLY
|
Professional
|
Both
|
$5,931.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
72000025
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$5,931.00 |
| Rate for Payer: Aetna Commercial |
$1,454.14
|
| Rate for Payer: Anthem Medicaid |
$870.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,931.00
|
| Rate for Payer: Cash Price |
$2,965.50
|
| Rate for Payer: Cash Price |
$2,965.50
|
| Rate for Payer: Cigna Commercial |
$1,345.28
|
| Rate for Payer: Healthspan PPO |
$1,055.45
|
| Rate for Payer: Humana Medicaid |
$870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,526.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$887.40
|
| Rate for Payer: Molina Healthcare Passport |
$870.00
|
| Rate for Payer: Multiplan PHCS |
$3,558.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,151.70
|
| Rate for Payer: UHCCP Medicaid |
$2,075.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$878.70
|
|
|
VBAC DELIVERY ONLY(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
720P0025
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,454.14
|
| Rate for Payer: Anthem Medicaid |
$870.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,345.28
|
| Rate for Payer: Healthspan PPO |
$1,055.45
|
| Rate for Payer: Humana Medicaid |
$870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,526.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$887.40
|
| Rate for Payer: Molina Healthcare Passport |
$870.00
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$878.70
|
|
|
VBAC DELIVERY ONLY(T
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
720T0025
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$485.03 |
| Max. Negotiated Rate |
$3,581.76 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.61
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
VBAC DELIVERY ONLY(T
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
720T0025
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$485.03 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem Medicaid |
$1,283.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| 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 |
$1,865.50
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Humana KY Medicaid |
$1,283.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.61
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
VECTIBIX(PANTM)10MG 100MG/5ML
|
Facility
|
OP
|
$9,403.32
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
25002670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$9,027.19 |
| Rate for Payer: Aetna Commercial |
$7,240.56
|
| Rate for Payer: Anthem Medicaid |
$3,233.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$150.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,334.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$210.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$203.39
|
| Rate for Payer: Cash Price |
$4,701.66
|
| Rate for Payer: Cash Price |
$4,701.66
|
| Rate for Payer: Cigna Commercial |
$7,804.76
|
| Rate for Payer: First Health Commercial |
$8,933.15
|
| Rate for Payer: Humana Commercial |
$7,992.82
|
| Rate for Payer: Humana KY Medicaid |
$3,233.80
|
| Rate for Payer: Humana Medicare Advantage |
$150.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,266.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,710.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,939.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,298.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,274.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,052.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,880.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,915.03
|
| Rate for Payer: PHCS Commercial |
$9,027.19
|
| Rate for Payer: United Healthcare All Payer |
$8,274.92
|
|
|
VECTIBIX(PANTM)10MG 100MG/5ML
|
Facility
|
IP
|
$9,403.32
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
25002670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,222.43 |
| Max. Negotiated Rate |
$9,027.19 |
| Rate for Payer: Aetna Commercial |
$7,240.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,334.59
|
| Rate for Payer: Cash Price |
$4,701.66
|
| Rate for Payer: Cigna Commercial |
$7,804.76
|
| Rate for Payer: First Health Commercial |
$8,933.15
|
| Rate for Payer: Humana Commercial |
$7,992.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,710.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,939.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,274.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,052.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,880.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,915.03
|
| Rate for Payer: PHCS Commercial |
$9,027.19
|
| Rate for Payer: United Healthcare All Payer |
$8,274.92
|
|
|
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 |
$495.95 |
| 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 |
$763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.65
|
| 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
|
OP
|
$3,815.00
|
|
|
Service Code
|
HCPCS 95716
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$495.95 |
| 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 |
$904.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,975.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,265.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,220.58
|
| 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 |
$904.13
|
| 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 |
$1,084.96
|
| 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 |
$763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,182.65
|
| Rate for Payer: PHCS Commercial |
$3,662.40
|
| Rate for Payer: United Healthcare All Payer |
$3,357.20
|
|
|
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 |
$3,815.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.69
|
| Rate for Payer: Anthem Medicaid |
$165.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,815.00
|
| Rate for Payer: Cash Price |
$1,907.50
|
| Rate for Payer: Cash Price |
$1,907.50
|
| Rate for Payer: Humana Medicaid |
$165.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$250.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.60
|
| Rate for Payer: Molina Healthcare Passport |
$165.29
|
| Rate for Payer: Multiplan PHCS |
$2,289.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,670.50
|
| Rate for Payer: UHCCP Medicaid |
$170.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$166.94
|
|
|
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: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.69
|
| Rate for Payer: Anthem Medicaid |
$165.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Humana Medicaid |
$165.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$250.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.60
|
| Rate for Payer: Molina Healthcare Passport |
$165.29
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.00
|
| Rate for Payer: UHCCP Medicaid |
$170.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$166.94
|
|
|
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 |
$466.05 |
| 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 |
$904.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,796.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,265.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,220.58
|
| 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 |
$904.13
|
| 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 |
$1,084.96
|
| 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 |
$717.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,111.35
|
| 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 |
$466.05 |
| 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 |
$717.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,111.35
|
| 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
|
IP
|
$21,174.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,752.70 |
| Max. Negotiated Rate |
$20,327.64 |
| Rate for Payer: Aetna Commercial |
$16,304.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,516.21
|
| Rate for Payer: Cash Price |
$10,587.32
|
| Rate for Payer: Cigna Commercial |
$17,574.94
|
| Rate for Payer: First Health Commercial |
$20,115.90
|
| Rate for Payer: Humana Commercial |
$17,998.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,363.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,626.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,352.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,633.67
|
| Rate for Payer: Ohio Health Group HMO |
$15,880.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,234.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,752.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,564.14
|
| Rate for Payer: PHCS Commercial |
$20,327.64
|
| Rate for Payer: United Healthcare All Payer |
$18,633.67
|
|
|
VEGA AS FEM COMP SZ 4R NX030Z
|
Facility
|
OP
|
$21,174.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,752.70 |
| Max. Negotiated Rate |
$20,327.64 |
| Rate for Payer: Aetna Commercial |
$16,304.47
|
| Rate for Payer: Anthem Medicaid |
$7,281.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,516.21
|
| Rate for Payer: Cash Price |
$10,587.32
|
| Rate for Payer: Cigna Commercial |
$17,574.94
|
| Rate for Payer: First Health Commercial |
$20,115.90
|
| Rate for Payer: Humana Commercial |
$17,998.44
|
| Rate for Payer: Humana KY Medicaid |
$7,281.96
|
| Rate for Payer: Kentucky WC Medicaid |
$7,356.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,363.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,626.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,352.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,428.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,633.67
|
| Rate for Payer: Ohio Health Group HMO |
$15,880.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,234.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,752.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,564.14
|
| Rate for Payer: PHCS Commercial |
$20,327.64
|
| Rate for Payer: United Healthcare All Payer |
$18,633.67
|
|
|
VEGA AS FEMUR COMP SZ 4 L
|
Facility
|
IP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
VEGA AS FEMUR COMP SZ 4 L
|
Facility
|
OP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem Medicaid |
$5,255.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Humana KY Medicaid |
$5,255.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,361.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
VEGA AS PS FEM COMP CEM F5R
|
Facility
|
IP
|
$21,174.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,752.70 |
| Max. Negotiated Rate |
$20,327.64 |
| Rate for Payer: Aetna Commercial |
$16,304.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,516.21
|
| Rate for Payer: Cash Price |
$10,587.32
|
| Rate for Payer: Cigna Commercial |
$17,574.94
|
| Rate for Payer: First Health Commercial |
$20,115.90
|
| Rate for Payer: Humana Commercial |
$17,998.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,363.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,626.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,352.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,633.67
|
| Rate for Payer: Ohio Health Group HMO |
$15,880.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,234.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,752.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,564.14
|
| Rate for Payer: PHCS Commercial |
$20,327.64
|
| Rate for Payer: United Healthcare All Payer |
$18,633.67
|
|
|
VEGA AS PS FEM COMP CEM F5R
|
Facility
|
OP
|
$21,174.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,752.70 |
| Max. Negotiated Rate |
$20,327.64 |
| Rate for Payer: Aetna Commercial |
$16,304.47
|
| Rate for Payer: Anthem Medicaid |
$7,281.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,516.21
|
| Rate for Payer: Cash Price |
$10,587.32
|
| Rate for Payer: Cigna Commercial |
$17,574.94
|
| Rate for Payer: First Health Commercial |
$20,115.90
|
| Rate for Payer: Humana Commercial |
$17,998.44
|
| Rate for Payer: Humana KY Medicaid |
$7,281.96
|
| Rate for Payer: Kentucky WC Medicaid |
$7,356.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,363.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,626.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,352.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,428.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,633.67
|
| Rate for Payer: Ohio Health Group HMO |
$15,880.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,234.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,752.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,564.14
|
| Rate for Payer: PHCS Commercial |
$20,327.64
|
| Rate for Payer: United Healthcare All Payer |
$18,633.67
|
|
|
VEGA AS PS TIB PLAT CEM T3
|
Facility
|
OP
|
$23,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,091.40 |
| Max. Negotiated Rate |
$22,828.80 |
| Rate for Payer: Aetna Commercial |
$18,310.60
|
| Rate for Payer: Anthem Medicaid |
$8,177.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,548.40
|
| Rate for Payer: Cash Price |
$11,890.00
|
| Rate for Payer: Cigna Commercial |
$19,737.40
|
| Rate for Payer: First Health Commercial |
$22,591.00
|
| Rate for Payer: Humana Commercial |
$20,213.00
|
| Rate for Payer: Humana KY Medicaid |
$8,177.94
|
| Rate for Payer: Kentucky WC Medicaid |
$8,261.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,499.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,549.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,134.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,342.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,926.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,835.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,756.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,091.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,371.80
|
| Rate for Payer: PHCS Commercial |
$22,828.80
|
| Rate for Payer: United Healthcare All Payer |
$20,926.40
|
|
|
VEGA AS PS TIB PLAT CEM T3
|
Facility
|
IP
|
$23,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,091.40 |
| Max. Negotiated Rate |
$22,828.80 |
| Rate for Payer: Aetna Commercial |
$18,310.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,548.40
|
| Rate for Payer: Cash Price |
$11,890.00
|
| Rate for Payer: Cigna Commercial |
$19,737.40
|
| Rate for Payer: First Health Commercial |
$22,591.00
|
| Rate for Payer: Humana Commercial |
$20,213.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,499.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,549.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,134.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,926.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,835.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,756.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,091.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,371.80
|
| Rate for Payer: PHCS Commercial |
$22,828.80
|
| Rate for Payer: United Healthcare All Payer |
$20,926.40
|
|
|
VEGA AS TIB EXT STEM 12*52MM
|
Facility
|
OP
|
$8,524.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.13 |
| Max. Negotiated Rate |
$8,183.15 |
| Rate for Payer: Aetna Commercial |
$6,563.56
|
| Rate for Payer: Anthem Medicaid |
$2,931.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.81
|
| Rate for Payer: Cash Price |
$4,262.06
|
| Rate for Payer: Cigna Commercial |
$7,075.01
|
| Rate for Payer: First Health Commercial |
$8,097.90
|
| Rate for Payer: Humana Commercial |
$7,245.49
|
| Rate for Payer: Humana KY Medicaid |
$2,931.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,501.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,393.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.47
|
| Rate for Payer: PHCS Commercial |
$8,183.15
|
| Rate for Payer: United Healthcare All Payer |
$7,501.22
|
|
