|
VENT ASSIST & MGNT
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 94004
|
| Hospital Charge Code |
41000101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem Medicaid |
$27.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.40
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Humana KY Medicaid |
$27.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.80
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
VENT ASSIST & MGNT
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 94004
|
| Hospital Charge Code |
41000101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.40
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.80
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
VENT ASSIST & MGNT(P
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 94004
|
| Hospital Charge Code |
410P0101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$73.43
|
| Rate for Payer: Anthem Medicaid |
$35.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$68.63
|
| Rate for Payer: Healthspan PPO |
$56.88
|
| Rate for Payer: Humana Medicaid |
$35.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.61
|
| Rate for Payer: Molina Healthcare Passport |
$35.89
|
| Rate for Payer: Multiplan PHCS |
$48.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.00
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.25
|
|
|
VENTILATING TUBE REMOVAL
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
76102419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.45 |
| Max. Negotiated Rate |
$4,002.00 |
| Rate for Payer: Aetna Commercial |
$90.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$34.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,002.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$88.02
|
| Rate for Payer: Healthspan PPO |
$156.20
|
| Rate for Payer: Humana Medicaid |
$34.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.14
|
| Rate for Payer: Molina Healthcare Passport |
$34.45
|
| Rate for Payer: Multiplan PHCS |
$2,401.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,801.40
|
| Rate for Payer: UHCCP Medicaid |
$37.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.79
|
|
|
VENTILATING TUBE REMOVAL
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
76102419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.26 |
| Max. Negotiated Rate |
$3,841.92 |
| Rate for Payer: Aetna Commercial |
$3,081.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.56
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$3,321.66
|
| Rate for Payer: First Health Commercial |
$3,801.90
|
| Rate for Payer: Humana Commercial |
$3,401.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,281.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,953.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,521.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,001.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.62
|
| Rate for Payer: PHCS Commercial |
$3,841.92
|
| Rate for Payer: United Healthcare All Payer |
$3,521.76
|
|
|
VENTILATING TUBE REMOVAL
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
76102419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.26 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$3,081.54
|
| Rate for Payer: Anthem Medicaid |
$1,376.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$3,321.66
|
| Rate for Payer: First Health Commercial |
$3,801.90
|
| Rate for Payer: Humana Commercial |
$3,401.70
|
| Rate for Payer: Humana KY Medicaid |
$1,376.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,390.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,281.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,953.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,521.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,001.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.62
|
| Rate for Payer: PHCS Commercial |
$3,841.92
|
| Rate for Payer: United Healthcare All Payer |
$3,521.76
|
|
|
VENTILATING TUBE REMOVAL(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
761P2419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.45 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$90.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$34.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$88.02
|
| Rate for Payer: Healthspan PPO |
$156.20
|
| Rate for Payer: Humana Medicaid |
$34.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.14
|
| Rate for Payer: Molina Healthcare Passport |
$34.45
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$37.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.79
|
|
|
VENTILATING TUBE REMOVAL(T
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
761T2419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem Medicaid |
$1,290.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Humana KY Medicaid |
$1,290.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,303.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,316.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,163.12
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
VENTILATING TUBE REMOVAL(T
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
761T2419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$3,601.92 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,163.12
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
VENTOLIN (ALBUTEROL) UD/S 3ML
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
NDC 60687039579
|
| Hospital Charge Code |
25001658
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
VENTOLIN (ALBUTEROL) UD/S 3ML
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 60687039579
|
| Hospital Charge Code |
25001658
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$25,195.59
|
|
|
Service Code
|
MSDRG 032
|
| Min. Negotiated Rate |
$17,097.01 |
| Max. Negotiated Rate |
$25,195.59 |
| Rate for Payer: Anthem Medicaid |
$17,097.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,996.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25,195.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$24,295.75
|
| Rate for Payer: Humana KY Medicaid |
$17,097.01
|
| Rate for Payer: Humana Medicare Advantage |
$17,996.85
|
| Rate for Payer: Kentucky WC Medicaid |
$17,267.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,596.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,438.95
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$48,156.85
|
|
|
Service Code
|
MSDRG 031
|
| Min. Negotiated Rate |
$32,677.86 |
| Max. Negotiated Rate |
$48,156.85 |
| Rate for Payer: Anthem Medicaid |
$32,677.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34,397.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48,156.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$46,436.96
|
| Rate for Payer: Humana KY Medicaid |
$32,677.86
|
| Rate for Payer: Humana Medicare Advantage |
$34,397.75
|
| Rate for Payer: Kentucky WC Medicaid |
$33,004.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41,277.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,331.42
|
|
|
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,985.01
|
|
|
Service Code
|
MSDRG 033
|
| Min. Negotiated Rate |
$12,882.68 |
| Max. Negotiated Rate |
$18,985.01 |
| Rate for Payer: Anthem Medicaid |
$12,882.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,560.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,985.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$18,306.97
|
| Rate for Payer: Humana KY Medicaid |
$12,882.68
|
| Rate for Payer: Humana Medicare Advantage |
$13,560.72
|
| Rate for Payer: Kentucky WC Medicaid |
$13,011.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,272.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,140.34
|
|
|
VENT SUBSEQUENT ASSIST/MANAGE
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
41000068
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$49.33 |
| Max. Negotiated Rate |
$907.00 |
| Rate for Payer: Aetna Commercial |
$101.03
|
| Rate for Payer: Anthem Medicaid |
$49.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$907.00
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$94.21
|
| Rate for Payer: Healthspan PPO |
$78.26
|
| Rate for Payer: Humana Medicaid |
$49.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.32
|
| Rate for Payer: Molina Healthcare Passport |
$49.33
|
| Rate for Payer: Multiplan PHCS |
$544.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$634.90
|
| Rate for Payer: UHCCP Medicaid |
$317.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.82
|
|
|
VENT SUBSEQUENT ASSIST/MANAGE
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
41000068
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$117.91 |
| Max. Negotiated Rate |
$870.72 |
| Rate for Payer: Aetna Commercial |
$698.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$707.46
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$752.81
|
| Rate for Payer: First Health Commercial |
$861.65
|
| Rate for Payer: Humana Commercial |
$770.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$743.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$669.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$798.16
|
| Rate for Payer: Ohio Health Group HMO |
$680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.17
|
| Rate for Payer: PHCS Commercial |
$870.72
|
| Rate for Payer: United Healthcare All Payer |
$798.16
|
|
|
VENT SUBSEQUENT ASSIST/MANAGE
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
41000068
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$117.91 |
| Max. Negotiated Rate |
$870.72 |
| Rate for Payer: Aetna Commercial |
$698.39
|
| Rate for Payer: Anthem Medicaid |
$311.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$541.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$707.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$758.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$731.58
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$752.81
|
| Rate for Payer: First Health Commercial |
$861.65
|
| Rate for Payer: Humana Commercial |
$770.95
|
| Rate for Payer: Humana KY Medicaid |
$311.92
|
| Rate for Payer: Humana Medicare Advantage |
$541.91
|
| Rate for Payer: Kentucky WC Medicaid |
$315.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$743.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$669.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$650.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$318.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$798.16
|
| Rate for Payer: Ohio Health Group HMO |
$680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.17
|
| Rate for Payer: PHCS Commercial |
$870.72
|
| Rate for Payer: United Healthcare All Payer |
$798.16
|
|
|
VENT SUBSEQUENT ASSIST/MANAG(P
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
410P0068
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$101.03
|
| Rate for Payer: Anthem Medicaid |
$49.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.00
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$94.21
|
| Rate for Payer: Healthspan PPO |
$78.26
|
| Rate for Payer: Humana Medicaid |
$49.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.32
|
| Rate for Payer: Molina Healthcare Passport |
$49.33
|
| Rate for Payer: Multiplan PHCS |
$69.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.50
|
| Rate for Payer: UHCCP Medicaid |
$40.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.82
|
|
|
VENT SUBSEQUENT ASSIST/MANAG(T
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
410T0068
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$98.54 |
| Max. Negotiated Rate |
$727.68 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$591.24
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cigna Commercial |
$629.14
|
| Rate for Payer: First Health Commercial |
$720.10
|
| Rate for Payer: Humana Commercial |
$644.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$667.04
|
| Rate for Payer: Ohio Health Group HMO |
$568.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.98
|
| Rate for Payer: PHCS Commercial |
$727.68
|
| Rate for Payer: United Healthcare All Payer |
$667.04
|
|
|
VENT SUBSEQUENT ASSIST/MANAG(T
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
410T0068
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$98.54 |
| Max. Negotiated Rate |
$758.67 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Anthem Medicaid |
$260.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$541.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$591.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$758.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$731.58
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cigna Commercial |
$629.14
|
| Rate for Payer: First Health Commercial |
$720.10
|
| Rate for Payer: Humana Commercial |
$644.30
|
| Rate for Payer: Humana KY Medicaid |
$260.68
|
| Rate for Payer: Humana Medicare Advantage |
$541.91
|
| Rate for Payer: Kentucky WC Medicaid |
$263.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$650.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$667.04
|
| Rate for Payer: Ohio Health Group HMO |
$568.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.98
|
| Rate for Payer: PHCS Commercial |
$727.68
|
| Rate for Payer: United Healthcare All Payer |
$667.04
|
|
|
VENTURE CATH OTW
|
Facility
|
OP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem Medicaid |
$1,614.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Humana KY Medicaid |
$1,614.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,631.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,647.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
VENTURE CATH OTW
|
Facility
|
IP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
VENTURE CATH RX
|
Facility
|
OP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem Medicaid |
$1,614.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Humana KY Medicaid |
$1,614.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,631.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,647.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
VENTURE CATH RX
|
Facility
|
IP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
VERAPAMIL IC KIT
|
Facility
|
OP
|
$191.50
|
|
|
Service Code
|
NDC 70069027105
|
| Hospital Charge Code |
25003568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$183.84 |
| Rate for Payer: Aetna Commercial |
$147.46
|
| Rate for Payer: Anthem Medicaid |
$65.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.37
|
| Rate for Payer: Cash Price |
$95.75
|
| Rate for Payer: Cigna Commercial |
$158.94
|
| Rate for Payer: First Health Commercial |
$181.92
|
| Rate for Payer: Humana Commercial |
$162.78
|
| Rate for Payer: Humana KY Medicaid |
$65.86
|
| Rate for Payer: Kentucky WC Medicaid |
$66.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.52
|
| Rate for Payer: Ohio Health Group HMO |
$143.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.36
|
| Rate for Payer: PHCS Commercial |
$183.84
|
| Rate for Payer: United Healthcare All Payer |
$168.52
|
|
