|
VAC ADM UNDER 18, PER 1ST ONLY
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
770T0061
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$29.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.08
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$29.58
|
| Rate for Payer: Kentucky WC Medicaid |
$29.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
VAC ADM UNDER 18, PER 1ST ONLY
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
77000061
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: Ambetter Exchange |
$21.10
|
| Rate for Payer: Anthem Medicaid |
$27.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.32
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$33.19
|
| Rate for Payer: Healthspan PPO |
$20.28
|
| Rate for Payer: Humana Medicaid |
$27.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$21.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.04
|
| Rate for Payer: Molina Healthcare Passport |
$27.49
|
| Rate for Payer: Multiplan PHCS |
$51.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.43
|
| Rate for Payer: UHCCP Medicaid |
$30.10
|
| Rate for Payer: United Healthcare Non-Options |
$25.67
|
| Rate for Payer: United Healthcare Options |
$21.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.10
|
|
|
VAC VIA 7 DAY THERAPY SYS KIT
|
Facility
|
IP
|
$4,715.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,414.50 |
| Max. Negotiated Rate |
$4,526.40 |
| Rate for Payer: Aetna Commercial |
$3,630.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,677.70
|
| Rate for Payer: Cash Price |
$2,357.50
|
| Rate for Payer: Cigna Commercial |
$3,913.45
|
| Rate for Payer: First Health Commercial |
$4,479.25
|
| Rate for Payer: Humana Commercial |
$4,007.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,866.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,479.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,149.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,102.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,253.35
|
| Rate for Payer: PHCS Commercial |
$4,526.40
|
| Rate for Payer: United Healthcare All Payer |
$4,149.20
|
|
|
VAC VIA 7 DAY THERAPY SYS KIT
|
Facility
|
OP
|
$4,715.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,414.50 |
| Max. Negotiated Rate |
$4,526.40 |
| Rate for Payer: Aetna Commercial |
$3,630.55
|
| Rate for Payer: Anthem Medicaid |
$1,621.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,677.70
|
| Rate for Payer: Cash Price |
$2,357.50
|
| Rate for Payer: Cigna Commercial |
$3,913.45
|
| Rate for Payer: First Health Commercial |
$4,479.25
|
| Rate for Payer: Humana Commercial |
$4,007.75
|
| Rate for Payer: Humana KY Medicaid |
$1,621.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,637.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,866.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,479.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,654.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,149.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,102.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,253.35
|
| Rate for Payer: PHCS Commercial |
$4,526.40
|
| Rate for Payer: United Healthcare All Payer |
$4,149.20
|
|
|
VAG DELIVERY ONLY
|
Facility
|
IP
|
$6,653.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
72000016
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,995.90 |
| Max. Negotiated Rate |
$6,386.88 |
| Rate for Payer: Aetna Commercial |
$5,122.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,189.34
|
| Rate for Payer: Cash Price |
$3,326.50
|
| Rate for Payer: Cigna Commercial |
$5,521.99
|
| Rate for Payer: First Health Commercial |
$6,320.35
|
| Rate for Payer: Humana Commercial |
$5,655.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,455.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,909.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,854.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,989.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,322.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,788.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,590.57
|
| Rate for Payer: PHCS Commercial |
$6,386.88
|
| Rate for Payer: United Healthcare All Payer |
$5,854.64
|
|
|
VAG DELIVERY ONLY
|
Facility
|
OP
|
$6,653.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
72000016
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,287.97 |
| Max. Negotiated Rate |
$6,386.88 |
| Rate for Payer: Aetna Commercial |
$5,122.81
|
| Rate for Payer: Anthem Medicaid |
$2,287.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,189.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$3,326.50
|
| Rate for Payer: Cash Price |
$3,326.50
|
| Rate for Payer: Cigna Commercial |
$5,521.99
|
| Rate for Payer: First Health Commercial |
$6,320.35
|
| Rate for Payer: Humana Commercial |
$5,655.05
|
| Rate for Payer: Humana KY Medicaid |
$2,287.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,311.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,455.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,909.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,333.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,854.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,989.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,322.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,788.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,590.57
|
| Rate for Payer: PHCS Commercial |
$6,386.88
|
| Rate for Payer: United Healthcare All Payer |
$5,854.64
|
|
|
VAG DELIVERY ONLY
|
Professional
|
Both
|
$6,653.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
72000016
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$763.53 |
| Max. Negotiated Rate |
$3,991.80 |
| Rate for Payer: Aetna Commercial |
$1,298.78
|
| Rate for Payer: Ambetter Exchange |
$763.53
|
| Rate for Payer: Anthem Medicaid |
$870.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$763.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$763.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$916.24
|
| Rate for Payer: Cash Price |
$3,326.50
|
| Rate for Payer: Cash Price |
$3,326.50
|
| Rate for Payer: Cigna Commercial |
$1,199.30
|
| Rate for Payer: Healthspan PPO |
$1,050.00
|
| Rate for Payer: Humana Medicaid |
$870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,361.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$763.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$763.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$887.40
|
| Rate for Payer: Molina Healthcare Passport |
$870.00
|
| Rate for Payer: Multiplan PHCS |
$3,991.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$992.59
|
| Rate for Payer: UHCCP Medicaid |
$2,328.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$878.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$763.53
|
|
|
VAG DELIVERY ONLY(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
720P0016
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,361.18 |
| Rate for Payer: Aetna Commercial |
$1,298.78
|
| Rate for Payer: Ambetter Exchange |
$763.53
|
| Rate for Payer: Anthem Medicaid |
$870.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$763.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$763.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$916.24
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,199.30
|
| Rate for Payer: Healthspan PPO |
$1,050.00
|
| Rate for Payer: Humana Medicaid |
$870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,361.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$763.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$763.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$887.40
|
| Rate for Payer: Molina Healthcare Passport |
$870.00
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$992.59
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$878.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$763.53
|
|
|
VAG DELIVERY ONLY(T
|
Facility
|
IP
|
$4,953.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
720T0016
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,485.90 |
| Max. Negotiated Rate |
$4,754.88 |
| Rate for Payer: Aetna Commercial |
$3,813.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,863.34
|
| Rate for Payer: Cash Price |
$2,476.50
|
| Rate for Payer: Cigna Commercial |
$4,110.99
|
| Rate for Payer: First Health Commercial |
$4,705.35
|
| Rate for Payer: Humana Commercial |
$4,210.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,061.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,655.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,485.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,358.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,714.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,962.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,309.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,417.57
|
| Rate for Payer: PHCS Commercial |
$4,754.88
|
| Rate for Payer: United Healthcare All Payer |
$4,358.64
|
|
|
VAG DELIVERY ONLY(T
|
Facility
|
OP
|
$4,953.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
720T0016
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,703.34 |
| Max. Negotiated Rate |
$4,754.88 |
| Rate for Payer: Aetna Commercial |
$3,813.81
|
| Rate for Payer: Anthem Medicaid |
$1,703.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,863.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$2,476.50
|
| Rate for Payer: Cash Price |
$2,476.50
|
| Rate for Payer: Cigna Commercial |
$4,110.99
|
| Rate for Payer: First Health Commercial |
$4,705.35
|
| Rate for Payer: Humana Commercial |
$4,210.05
|
| Rate for Payer: Humana KY Medicaid |
$1,703.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,720.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,061.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,655.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,737.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,358.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,714.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,962.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,309.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,417.57
|
| Rate for Payer: PHCS Commercial |
$4,754.88
|
| Rate for Payer: United Healthcare All Payer |
$4,358.64
|
|
|
VAG DELIVERY ONLY W/POST CARE
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 59410
|
| Hospital Charge Code |
72000017
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,519.25 |
| Rate for Payer: Aetna Commercial |
$1,498.35
|
| Rate for Payer: Ambetter Exchange |
$1,031.62
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,031.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,031.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,237.94
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,374.92
|
| Rate for Payer: Healthspan PPO |
$1,180.00
|
| Rate for Payer: Humana Medicaid |
$900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,519.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,031.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.00
|
| Rate for Payer: Molina Healthcare Passport |
$900.00
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,341.11
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,031.62
|
|
|
VAG DELIVERY ONLY W/POST CARE
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 59410
|
| Hospital Charge Code |
72000017
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
VAG DELIVERY ONLY W/POST CARE
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 59410
|
| Hospital Charge Code |
72000017
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
VAG DELIVERY ONLY W/POST CAR(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 59410
|
| Hospital Charge Code |
720P0017
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,519.25 |
| Rate for Payer: Aetna Commercial |
$1,498.35
|
| Rate for Payer: Ambetter Exchange |
$1,031.62
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,031.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,031.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,237.94
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,374.92
|
| Rate for Payer: Healthspan PPO |
$1,180.00
|
| Rate for Payer: Humana Medicaid |
$900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,519.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,031.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.00
|
| Rate for Payer: Molina Healthcare Passport |
$900.00
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,341.11
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,031.62
|
|
|
VAG HYST
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58260
|
| Hospital Charge Code |
76102214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.38 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,252.96
|
| Rate for Payer: Ambetter Exchange |
$794.32
|
| Rate for Payer: Anthem Medicaid |
$636.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$794.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$794.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$953.18
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,220.74
|
| Rate for Payer: Healthspan PPO |
$1,213.18
|
| Rate for Payer: Humana Medicaid |
$636.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,075.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$794.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$794.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$649.11
|
| Rate for Payer: Molina Healthcare Passport |
$636.38
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,032.62
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$642.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$794.32
|
|
|
VAG HYST
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58260
|
| Hospital Charge Code |
76102214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VAG HYST
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58260
|
| Hospital Charge Code |
76102214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,031.70 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VAG HYST INCL T/O COMPLEX
|
Facility
|
IP
|
$3,038.00
|
|
|
Service Code
|
HCPCS 58291
|
| Hospital Charge Code |
76102961
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$911.40 |
| Max. Negotiated Rate |
$2,916.48 |
| Rate for Payer: Aetna Commercial |
$2,339.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,369.64
|
| Rate for Payer: Cash Price |
$1,519.00
|
| Rate for Payer: Cigna Commercial |
$2,521.54
|
| Rate for Payer: First Health Commercial |
$2,886.10
|
| Rate for Payer: Humana Commercial |
$2,582.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,491.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,242.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,673.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,278.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,430.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,643.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,096.22
|
| Rate for Payer: PHCS Commercial |
$2,916.48
|
| Rate for Payer: United Healthcare All Payer |
$2,673.44
|
|
|
VAG HYST INCL T/O COMPLEX
|
Facility
|
OP
|
$3,038.00
|
|
|
Service Code
|
HCPCS 58291
|
| Hospital Charge Code |
76102961
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,044.77 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$2,339.26
|
| Rate for Payer: Anthem Medicaid |
$1,044.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,369.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Cash Price |
$1,519.00
|
| Rate for Payer: Cash Price |
$1,519.00
|
| Rate for Payer: Cigna Commercial |
$2,521.54
|
| Rate for Payer: First Health Commercial |
$2,886.10
|
| Rate for Payer: Humana Commercial |
$2,582.30
|
| Rate for Payer: Humana KY Medicaid |
$1,044.77
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,055.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,491.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,242.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,065.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,673.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,278.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,430.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,643.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,096.22
|
| Rate for Payer: PHCS Commercial |
$2,916.48
|
| Rate for Payer: United Healthcare All Payer |
$2,673.44
|
|
|
VAG HYST INCL T/O COMPLEX
|
Professional
|
Both
|
$3,038.00
|
|
|
Service Code
|
HCPCS 58291
|
| Hospital Charge Code |
76102961
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.96 |
| Max. Negotiated Rate |
$1,914.55 |
| Rate for Payer: Aetna Commercial |
$1,914.55
|
| Rate for Payer: Ambetter Exchange |
$1,178.39
|
| Rate for Payer: Anthem Medicaid |
$900.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,178.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,178.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,414.07
|
| Rate for Payer: Cash Price |
$1,519.00
|
| Rate for Payer: Cash Price |
$1,519.00
|
| Rate for Payer: Cigna Commercial |
$1,873.19
|
| Rate for Payer: Healthspan PPO |
$1,853.77
|
| Rate for Payer: Humana Medicaid |
$900.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,629.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,178.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,178.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.98
|
| Rate for Payer: Molina Healthcare Passport |
$900.96
|
| Rate for Payer: Multiplan PHCS |
$1,822.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,531.91
|
| Rate for Payer: UHCCP Medicaid |
$1,063.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,178.39
|
|
|
VAG HYST(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58260
|
| Hospital Charge Code |
761P2214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.38 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,252.96
|
| Rate for Payer: Ambetter Exchange |
$794.32
|
| Rate for Payer: Anthem Medicaid |
$636.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$794.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$794.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$953.18
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,220.74
|
| Rate for Payer: Healthspan PPO |
$1,213.18
|
| Rate for Payer: Humana Medicaid |
$636.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,075.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$794.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$794.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$649.11
|
| Rate for Payer: Molina Healthcare Passport |
$636.38
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,032.62
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$642.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$794.32
|
|
|
VAG HYST W/ANTERIOR REPAIR
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58267
|
| Hospital Charge Code |
76102216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VAG HYST W/ANTERIOR REPAIR
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58267
|
| Hospital Charge Code |
76102216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$778.08 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,605.99
|
| Rate for Payer: Ambetter Exchange |
$1,012.69
|
| Rate for Payer: Anthem Medicaid |
$778.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,012.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,012.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,215.23
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,568.22
|
| Rate for Payer: Healthspan PPO |
$1,555.01
|
| Rate for Payer: Humana Medicaid |
$778.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,375.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,012.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,012.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$793.64
|
| Rate for Payer: Molina Healthcare Passport |
$778.08
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,316.50
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$785.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,012.69
|
|
|
VAG HYST W/ANTERIOR REPAIR
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58267
|
| Hospital Charge Code |
76102216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VAG HYST W/ANTERIOR REPAIR(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58267
|
| Hospital Charge Code |
761P2216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$778.08 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,605.99
|
| Rate for Payer: Ambetter Exchange |
$1,012.69
|
| Rate for Payer: Anthem Medicaid |
$778.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,012.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,012.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,215.23
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,568.22
|
| Rate for Payer: Healthspan PPO |
$1,555.01
|
| Rate for Payer: Humana Medicaid |
$778.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,375.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,012.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,012.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$793.64
|
| Rate for Payer: Molina Healthcare Passport |
$778.08
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,316.50
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$785.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,012.69
|
|
