|
VESEL MAPING VESS HEMO GRAFT
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS G0365
|
| Hospital Charge Code |
76102537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
VESEL MAPING VESS HEMO GRAFT
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS G0365
|
| Hospital Charge Code |
76102537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
VESICARE 5 MG TAB
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 67877052790
|
| Hospital Charge Code |
25001663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
VESICARE 5 MG TAB
|
Facility
|
OP
|
$4.60
|
|
|
Service Code
|
NDC 67877052790
|
| Hospital Charge Code |
25001663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
VESSEL INJECTION PROCEDURE
|
Facility
|
OP
|
$1,960.00
|
|
|
Service Code
|
HCPCS 36299
|
| Hospital Charge Code |
76102577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.80 |
| Max. Negotiated Rate |
$1,881.60 |
| Rate for Payer: Aetna Commercial |
$1,509.20
|
| Rate for Payer: Anthem Medicaid |
$674.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,528.80
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cigna Commercial |
$1,626.80
|
| Rate for Payer: First Health Commercial |
$1,862.00
|
| Rate for Payer: Humana Commercial |
$1,666.00
|
| Rate for Payer: Humana KY Medicaid |
$674.04
|
| Rate for Payer: Kentucky WC Medicaid |
$680.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,607.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,446.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$687.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,724.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,470.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.60
|
| Rate for Payer: PHCS Commercial |
$1,881.60
|
| Rate for Payer: United Healthcare All Payer |
$1,724.80
|
|
|
VESSEL INJECTION PROCEDURE
|
Professional
|
Both
|
$1,960.00
|
|
|
Service Code
|
HCPCS 36299
|
| Hospital Charge Code |
76102577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,960.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,960.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,176.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,372.00
|
| Rate for Payer: UHCCP Medicaid |
$686.00
|
|
|
VESSEL INJECTION PROCEDURE
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 36299
|
| Hospital Charge Code |
761T2577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.80 |
| Max. Negotiated Rate |
$1,689.60 |
| Rate for Payer: Aetna Commercial |
$1,355.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.80
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,460.80
|
| Rate for Payer: First Health Commercial |
$1,672.00
|
| Rate for Payer: Humana Commercial |
$1,496.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.60
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
VESSEL INJECTION PROCEDURE
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 36299
|
| Hospital Charge Code |
761T2577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.80 |
| Max. Negotiated Rate |
$1,689.60 |
| Rate for Payer: Aetna Commercial |
$1,355.20
|
| Rate for Payer: Anthem Medicaid |
$605.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.80
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,460.80
|
| Rate for Payer: First Health Commercial |
$1,672.00
|
| Rate for Payer: Humana Commercial |
$1,496.00
|
| Rate for Payer: Humana KY Medicaid |
$605.26
|
| Rate for Payer: Kentucky WC Medicaid |
$611.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.60
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
VESSEL INJECTION PROCEDURE
|
Facility
|
IP
|
$1,960.00
|
|
|
Service Code
|
HCPCS 36299
|
| Hospital Charge Code |
76102577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.80 |
| Max. Negotiated Rate |
$1,881.60 |
| Rate for Payer: Aetna Commercial |
$1,509.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,528.80
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cigna Commercial |
$1,626.80
|
| Rate for Payer: First Health Commercial |
$1,862.00
|
| Rate for Payer: Humana Commercial |
$1,666.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,607.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,446.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,724.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,470.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.60
|
| Rate for Payer: PHCS Commercial |
$1,881.60
|
| Rate for Payer: United Healthcare All Payer |
$1,724.80
|
|
|
VFC ADMN EACH ADD KY
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
77000135
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$19.13 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.55
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cigna Commercial |
$16.54
|
| Rate for Payer: First Health Commercial |
$18.93
|
| Rate for Payer: Humana Commercial |
$16.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.54
|
| Rate for Payer: Ohio Health Group HMO |
$14.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.18
|
| Rate for Payer: PHCS Commercial |
$19.13
|
| Rate for Payer: United Healthcare All Payer |
$17.54
|
|
|
VFC ADMN EACH ADD KY
|
Professional
|
Both
|
$19.93
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
77000135
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Buckeye Medicare Advantage |
$19.93
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cigna Commercial |
$16.84
|
| Rate for Payer: Healthspan PPO |
$10.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.43
|
| Rate for Payer: Multiplan PHCS |
$11.96
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.95
|
| Rate for Payer: UHCCP Medicaid |
$6.98
|
|
|
VFC ADMN EACH ADD KY
|
Facility
|
OP
|
$19.93
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
77000135
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$19.13 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Anthem Medicaid |
$6.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.55
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cigna Commercial |
$16.54
|
| Rate for Payer: First Health Commercial |
$18.93
|
| Rate for Payer: Humana Commercial |
$16.94
|
| Rate for Payer: Humana KY Medicaid |
$6.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.54
|
| Rate for Payer: Ohio Health Group HMO |
$14.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.18
|
| Rate for Payer: PHCS Commercial |
$19.13
|
| Rate for Payer: United Healthcare All Payer |
$17.54
|
|
|
VFC ADMN EACH ADD KY (T
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
770T0135
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$19.13 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.55
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cigna Commercial |
$16.54
|
| Rate for Payer: First Health Commercial |
$18.93
|
| Rate for Payer: Humana Commercial |
$16.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.54
|
| Rate for Payer: Ohio Health Group HMO |
$14.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.18
|
| Rate for Payer: PHCS Commercial |
$19.13
|
| Rate for Payer: United Healthcare All Payer |
$17.54
|
|
|
VFC ADMN EACH ADD KY (T
|
Facility
|
OP
|
$19.93
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
770T0135
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$19.13 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Anthem Medicaid |
$6.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.55
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cigna Commercial |
$16.54
|
| Rate for Payer: First Health Commercial |
$18.93
|
| Rate for Payer: Humana Commercial |
$16.94
|
| Rate for Payer: Humana KY Medicaid |
$6.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.54
|
| Rate for Payer: Ohio Health Group HMO |
$14.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.18
|
| Rate for Payer: PHCS Commercial |
$19.13
|
| Rate for Payer: United Healthcare All Payer |
$17.54
|
|
|
VFC ADMN EACH ADD OH
|
Facility
|
OP
|
$21.25
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
77000134
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Anthem Medicaid |
$7.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.58
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cigna Commercial |
$17.64
|
| Rate for Payer: First Health Commercial |
$20.19
|
| Rate for Payer: Humana Commercial |
$18.06
|
| Rate for Payer: Humana KY Medicaid |
$7.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.70
|
| Rate for Payer: Ohio Health Group HMO |
$15.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.59
|
| Rate for Payer: PHCS Commercial |
$20.40
|
| Rate for Payer: United Healthcare All Payer |
$18.70
|
|
|
VFC ADMN EACH ADD OH
|
Facility
|
IP
|
$21.25
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
77000134
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: PHCS Commercial |
$20.40
|
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.58
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cigna Commercial |
$17.64
|
| Rate for Payer: First Health Commercial |
$20.19
|
| Rate for Payer: Humana Commercial |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.70
|
| Rate for Payer: Ohio Health Group HMO |
$15.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.59
|
| Rate for Payer: United Healthcare All Payer |
$18.70
|
|
|
VFC ADMN EACH ADD OH
|
Professional
|
Both
|
$21.25
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
77000134
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Buckeye Medicare Advantage |
$21.25
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cigna Commercial |
$16.84
|
| Rate for Payer: Healthspan PPO |
$10.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.43
|
| Rate for Payer: Multiplan PHCS |
$12.75
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.88
|
| Rate for Payer: UHCCP Medicaid |
$7.44
|
|
|
VFC ADMN EACH ADD OH (T
|
Facility
|
OP
|
$21.25
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
770T0134
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Anthem Medicaid |
$7.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.58
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cigna Commercial |
$17.64
|
| Rate for Payer: First Health Commercial |
$20.19
|
| Rate for Payer: Humana Commercial |
$18.06
|
| Rate for Payer: Humana KY Medicaid |
$7.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.70
|
| Rate for Payer: Ohio Health Group HMO |
$15.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.59
|
| Rate for Payer: PHCS Commercial |
$20.40
|
| Rate for Payer: United Healthcare All Payer |
$18.70
|
|
|
VFC ADMN EACH ADD OH (T
|
Facility
|
IP
|
$21.25
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
770T0134
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.58
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cigna Commercial |
$17.64
|
| Rate for Payer: First Health Commercial |
$20.19
|
| Rate for Payer: Humana Commercial |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.70
|
| Rate for Payer: Ohio Health Group HMO |
$15.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.59
|
| Rate for Payer: PHCS Commercial |
$20.40
|
| Rate for Payer: United Healthcare All Payer |
$18.70
|
|
|
VFC ADMN ONLY KY
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
77000133
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$19.13 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.55
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cigna Commercial |
$16.54
|
| Rate for Payer: First Health Commercial |
$18.93
|
| Rate for Payer: Humana Commercial |
$16.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.54
|
| Rate for Payer: Ohio Health Group HMO |
$14.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.18
|
| Rate for Payer: PHCS Commercial |
$19.13
|
| Rate for Payer: United Healthcare All Payer |
$17.54
|
|
|
VFC ADMN ONLY KY
|
Professional
|
Both
|
$19.93
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
77000133
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$33.19 |
| Rate for Payer: Buckeye Medicare Advantage |
$19.93
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cash Price |
$9.96
|
| 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 |
$11.96
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.95
|
| Rate for Payer: UHCCP Medicaid |
$6.98
|
| Rate for Payer: United Healthcare Non-Options |
$25.67
|
| Rate for Payer: United Healthcare Options |
$21.02
|
|
|
VFC ADMN ONLY KY
|
Facility
|
OP
|
$19.93
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
77000133
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$19.13 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Anthem Medicaid |
$6.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.55
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cigna Commercial |
$16.54
|
| Rate for Payer: First Health Commercial |
$18.93
|
| Rate for Payer: Humana Commercial |
$16.94
|
| Rate for Payer: Humana KY Medicaid |
$6.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.54
|
| Rate for Payer: Ohio Health Group HMO |
$14.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.18
|
| Rate for Payer: PHCS Commercial |
$19.13
|
| Rate for Payer: United Healthcare All Payer |
$17.54
|
|
|
VFC ADMN ONLY KY
|
Facility
|
OP
|
$19.93
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
770T0133
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$19.13 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Anthem Medicaid |
$6.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.55
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cigna Commercial |
$16.54
|
| Rate for Payer: First Health Commercial |
$18.93
|
| Rate for Payer: Humana Commercial |
$16.94
|
| Rate for Payer: Humana KY Medicaid |
$6.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.54
|
| Rate for Payer: Ohio Health Group HMO |
$14.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.18
|
| Rate for Payer: PHCS Commercial |
$19.13
|
| Rate for Payer: United Healthcare All Payer |
$17.54
|
|
|
VFC ADMN ONLY KY
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
770T0133
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$19.13 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.55
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cigna Commercial |
$16.54
|
| Rate for Payer: First Health Commercial |
$18.93
|
| Rate for Payer: Humana Commercial |
$16.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.54
|
| Rate for Payer: Ohio Health Group HMO |
$14.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.18
|
| Rate for Payer: PHCS Commercial |
$19.13
|
| Rate for Payer: United Healthcare All Payer |
$17.54
|
|
|
VFC ADMN ONLY OH
|
Facility
|
IP
|
$21.25
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
770T0132
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.58
|
| Rate for Payer: Cash Price |
$10.62
|
| Rate for Payer: Cigna Commercial |
$17.64
|
| Rate for Payer: First Health Commercial |
$20.19
|
| Rate for Payer: Humana Commercial |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.70
|
| Rate for Payer: Ohio Health Group HMO |
$15.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.59
|
| Rate for Payer: PHCS Commercial |
$20.40
|
| Rate for Payer: United Healthcare All Payer |
$18.70
|
|
