|
VFC ADMN ONLY OH
|
Facility
|
OP
|
$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 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 ONLY OH
|
Professional
|
Both
|
$21.25
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
77000132
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$33.19 |
| 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 |
$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 |
$12.75
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.88
|
| Rate for Payer: UHCCP Medicaid |
$7.44
|
| Rate for Payer: United Healthcare Non-Options |
$25.67
|
| Rate for Payer: United Healthcare Options |
$21.02
|
|
|
VFC ADMN ONLY OH
|
Facility
|
IP
|
$21.25
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
77000132
|
|
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 OH
|
Facility
|
OP
|
$21.25
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
77000132
|
|
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 W/O CNSL 2+ KY
|
Professional
|
Both
|
$19.93
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
77000137
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Aetna Commercial |
$16.01
|
| 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 |
$14.56
|
| Rate for Payer: Healthspan PPO |
$12.24
|
| 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 W/O CNSL 2+ KY
|
Facility
|
OP
|
$19.93
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
77000137
|
|
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 W/O CNSL 2+ KY
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
77000137
|
|
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 W/O CNSL 2+ KY (T
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
770T0137
|
|
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 W/O CNSL 2+ KY (T
|
Facility
|
OP
|
$19.93
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
770T0137
|
|
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 W/O CNSL 2+OH
|
Facility
|
OP
|
$21.25
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
77000139
|
|
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 W/O CNSL 2+OH
|
Professional
|
Both
|
$21.25
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
77000139
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna Commercial |
$16.01
|
| 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 |
$14.56
|
| Rate for Payer: Healthspan PPO |
$12.24
|
| 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 W/O CNSL 2+OH
|
Facility
|
IP
|
$21.25
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
77000139
|
|
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 W/O CNSL 2+OH (T
|
Facility
|
OP
|
$21.25
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
770T0139
|
|
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 W/O CNSL 2+OH (T
|
Facility
|
IP
|
$21.25
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
770T0139
|
|
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 W/O CNSL KY
|
Professional
|
Both
|
$19.93
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
77000138
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$28.79 |
| 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 |
$28.79
|
| Rate for Payer: Healthspan PPO |
$23.94
|
| 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
|
|
|
VFC ADMN W/O CNSL KY
|
Facility
|
OP
|
$19.93
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
77000138
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$85.29 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Anthem Medicaid |
$6.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$60.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$85.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.24
|
| Rate for Payer: Cash Price |
$9.96
|
| 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: Humana Medicare Advantage |
$60.92
|
| 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 |
$73.10
|
| 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 W/O CNSL KY
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
77000138
|
|
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 W/O CNSL KY (T
|
Facility
|
OP
|
$19.93
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
770T0138
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$85.29 |
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Anthem Medicaid |
$6.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$60.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$85.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.24
|
| Rate for Payer: Cash Price |
$9.96
|
| 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: Humana Medicare Advantage |
$60.92
|
| 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 |
$73.10
|
| 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 W/O CNSL KY (T
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
770T0138
|
|
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 W/O CNSL OH
|
Professional
|
Both
|
$21.25
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
77000136
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$28.79 |
| 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 |
$28.79
|
| Rate for Payer: Healthspan PPO |
$23.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.58
|
| 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 W/O CNSL OH
|
Facility
|
IP
|
$21.25
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
77000136
|
|
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 W/O CNSL OH
|
Facility
|
OP
|
$21.25
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
77000136
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$85.29 |
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Anthem Medicaid |
$7.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$60.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$85.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.24
|
| Rate for Payer: Cash Price |
$10.62
|
| 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: Humana Medicare Advantage |
$60.92
|
| 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 |
$73.10
|
| 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 W/O CNSL OH (T
|
Facility
|
OP
|
$21.25
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
770T0136
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$85.29 |
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Anthem Medicaid |
$7.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$60.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$85.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.24
|
| Rate for Payer: Cash Price |
$10.62
|
| 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: Humana Medicare Advantage |
$60.92
|
| 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 |
$73.10
|
| 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 W/O CNSL OH (T
|
Facility
|
IP
|
$21.25
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
770T0136
|
|
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
|
|
|
VFEND I.V. 10MG (200MG VIAL)
|
Facility
|
IP
|
$329.30
|
|
|
Service Code
|
HCPCS J3465
|
| Hospital Charge Code |
25002431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$316.13 |
| Rate for Payer: Aetna Commercial |
$253.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$256.85
|
| Rate for Payer: Cash Price |
$164.65
|
| Rate for Payer: Cigna Commercial |
$273.32
|
| Rate for Payer: First Health Commercial |
$312.84
|
| Rate for Payer: Humana Commercial |
$279.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$270.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$243.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$289.78
|
| Rate for Payer: Ohio Health Group HMO |
$246.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.08
|
| Rate for Payer: PHCS Commercial |
$316.13
|
| Rate for Payer: United Healthcare All Payer |
$289.78
|
|
