|
VARIAX FIBULA PLATE 6 H
|
Facility
|
IP
|
$3,987.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$3,828.00 |
| Rate for Payer: Aetna Commercial |
$3,070.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,110.25
|
| Rate for Payer: Cash Price |
$1,993.75
|
| Rate for Payer: Cigna Commercial |
$3,309.62
|
| Rate for Payer: First Health Commercial |
$3,788.12
|
| Rate for Payer: Humana Commercial |
$3,389.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,269.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,509.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,990.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,469.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,751.38
|
| Rate for Payer: PHCS Commercial |
$3,828.00
|
| Rate for Payer: United Healthcare All Payer |
$3,509.00
|
|
|
VARIAX FIBULA PLATE 7 H
|
Facility
|
OP
|
$4,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.00 |
| Max. Negotiated Rate |
$3,993.60 |
| Rate for Payer: Aetna Commercial |
$3,203.20
|
| Rate for Payer: Anthem Medicaid |
$1,430.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,244.80
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cigna Commercial |
$3,452.80
|
| Rate for Payer: First Health Commercial |
$3,952.00
|
| Rate for Payer: Humana Commercial |
$3,536.00
|
| Rate for Payer: Humana KY Medicaid |
$1,430.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,445.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,411.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,070.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,248.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,459.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,660.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,619.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,870.40
|
| Rate for Payer: PHCS Commercial |
$3,993.60
|
| Rate for Payer: United Healthcare All Payer |
$3,660.80
|
|
|
VARIAX FIBULA PLATE 7 H
|
Facility
|
IP
|
$4,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.00 |
| Max. Negotiated Rate |
$3,993.60 |
| Rate for Payer: Aetna Commercial |
$3,203.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,244.80
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cigna Commercial |
$3,452.80
|
| Rate for Payer: First Health Commercial |
$3,952.00
|
| Rate for Payer: Humana Commercial |
$3,536.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,411.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,070.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,248.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,660.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,619.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,870.40
|
| Rate for Payer: PHCS Commercial |
$3,993.60
|
| Rate for Payer: United Healthcare All Payer |
$3,660.80
|
|
|
VARIAX FIBULA PLATE 7H STR
|
Facility
|
OP
|
$4,655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.50 |
| Max. Negotiated Rate |
$4,468.80 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Anthem Medicaid |
$1,600.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,630.90
|
| Rate for Payer: Cash Price |
$2,327.50
|
| Rate for Payer: Cigna Commercial |
$3,863.65
|
| Rate for Payer: First Health Commercial |
$4,422.25
|
| Rate for Payer: Humana Commercial |
$3,956.75
|
| Rate for Payer: Humana KY Medicaid |
$1,600.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,617.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,632.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,049.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,211.95
|
| Rate for Payer: PHCS Commercial |
$4,468.80
|
| Rate for Payer: United Healthcare All Payer |
$4,096.40
|
|
|
VARIAX FIBULA PLATE 7H STR
|
Facility
|
IP
|
$4,655.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.50 |
| Max. Negotiated Rate |
$4,468.80 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,630.90
|
| Rate for Payer: Cash Price |
$2,327.50
|
| Rate for Payer: Cigna Commercial |
$3,863.65
|
| Rate for Payer: First Health Commercial |
$4,422.25
|
| Rate for Payer: Humana Commercial |
$3,956.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,049.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,211.95
|
| Rate for Payer: PHCS Commercial |
$4,468.80
|
| Rate for Payer: United Healthcare All Payer |
$4,096.40
|
|
|
VARIAX FIBULA PLATE 8 H
|
Facility
|
IP
|
$4,000.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.18 |
| Max. Negotiated Rate |
$3,840.57 |
| Rate for Payer: Aetna Commercial |
$3,080.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.46
|
| Rate for Payer: Cash Price |
$2,000.29
|
| Rate for Payer: Cigna Commercial |
$3,320.49
|
| Rate for Payer: First Health Commercial |
$3,800.56
|
| Rate for Payer: Humana Commercial |
$3,400.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.41
|
| Rate for Payer: PHCS Commercial |
$3,840.57
|
| Rate for Payer: United Healthcare All Payer |
$3,520.52
|
|
|
VARIAX FIBULA PLATE 8 H
|
Facility
|
OP
|
$4,000.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.18 |
| Max. Negotiated Rate |
$3,840.57 |
| Rate for Payer: Aetna Commercial |
$3,080.45
|
| Rate for Payer: Anthem Medicaid |
$1,375.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.46
|
| Rate for Payer: Cash Price |
$2,000.29
|
| Rate for Payer: Cigna Commercial |
$3,320.49
|
| Rate for Payer: First Health Commercial |
$3,800.56
|
| Rate for Payer: Humana Commercial |
$3,400.50
|
| Rate for Payer: Humana KY Medicaid |
$1,375.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.41
|
| Rate for Payer: PHCS Commercial |
$3,840.57
|
| Rate for Payer: United Healthcare All Payer |
$3,520.52
|
|
|
VARIAX FIBULA PLATE 9 H
|
Facility
|
OP
|
$5,238.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.51 |
| Max. Negotiated Rate |
$5,028.82 |
| Rate for Payer: Aetna Commercial |
$4,033.53
|
| Rate for Payer: Anthem Medicaid |
$1,801.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,085.91
|
| Rate for Payer: Cash Price |
$2,619.18
|
| Rate for Payer: Cigna Commercial |
$4,347.83
|
| Rate for Payer: First Health Commercial |
$4,976.43
|
| Rate for Payer: Humana Commercial |
$4,452.60
|
| Rate for Payer: Humana KY Medicaid |
$1,801.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,819.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,295.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,865.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,571.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,837.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,609.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,928.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,190.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,557.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,614.46
|
| Rate for Payer: PHCS Commercial |
$5,028.82
|
| Rate for Payer: United Healthcare All Payer |
$4,609.75
|
|
|
VARIAX FIBULA PLATE 9 H
|
Facility
|
IP
|
$5,238.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.51 |
| Max. Negotiated Rate |
$5,028.82 |
| Rate for Payer: Aetna Commercial |
$4,033.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,085.91
|
| Rate for Payer: Cash Price |
$2,619.18
|
| Rate for Payer: Cigna Commercial |
$4,347.83
|
| Rate for Payer: First Health Commercial |
$4,976.43
|
| Rate for Payer: Humana Commercial |
$4,452.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,295.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,865.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,571.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,609.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,928.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,190.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,557.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,614.46
|
| Rate for Payer: PHCS Commercial |
$5,028.82
|
| Rate for Payer: United Healthcare All Payer |
$4,609.75
|
|
|
VARICELLA VACCINE LIVE
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
77000044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.68 |
| Max. Negotiated Rate |
$260.40 |
| Rate for Payer: Anthem Medicaid |
$150.98
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Healthspan PPO |
$101.68
|
| Rate for Payer: Humana Medicaid |
$150.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$242.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$154.00
|
| Rate for Payer: Molina Healthcare Passport |
$150.98
|
| Rate for Payer: Multiplan PHCS |
$223.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$260.40
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$152.49
|
|
|
VARICELLA VACCINE LIVE
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
77000044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem Medicaid |
$127.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Humana KY Medicaid |
$127.93
|
| Rate for Payer: Kentucky WC Medicaid |
$129.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.68
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
VARICELLA VACCINE LIVE
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
77000044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.68
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
VARICELLA VACCINE LIVE(T
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
770T0044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.68
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
VARICELLA VACCINE LIVE(T
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
770T0044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem Medicaid |
$127.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Humana KY Medicaid |
$127.93
|
| Rate for Payer: Kentucky WC Medicaid |
$129.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.68
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
VARICELLA ZOSTER AB SCREEN
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
30001217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$170.88 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: Anthem Medicaid |
$12.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.88
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cigna Commercial |
$147.74
|
| Rate for Payer: First Health Commercial |
$169.10
|
| Rate for Payer: Humana Commercial |
$151.30
|
| Rate for Payer: Humana KY Medicaid |
$12.88
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Kentucky WC Medicaid |
$13.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$131.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$156.64
|
| Rate for Payer: Ohio Health Group HMO |
$133.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.82
|
| Rate for Payer: PHCS Commercial |
$170.88
|
| Rate for Payer: United Healthcare All Payer |
$156.64
|
|
|
VARICELLA ZOSTER AB SCREEN
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
30001217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$170.88 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.93
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cigna Commercial |
$147.74
|
| Rate for Payer: First Health Commercial |
$169.10
|
| Rate for Payer: Humana Commercial |
$151.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$131.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$156.64
|
| Rate for Payer: Ohio Health Group HMO |
$133.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.82
|
| Rate for Payer: PHCS Commercial |
$170.88
|
| Rate for Payer: United Healthcare All Payer |
$156.64
|
|
|
VARIZIG 125 UNIT/1.2 ML VL
|
Facility
|
IP
|
$4,030.76
|
|
|
Service Code
|
HCPCS 90396
|
| Hospital Charge Code |
25003878
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,209.23 |
| Max. Negotiated Rate |
$3,869.53 |
| Rate for Payer: Aetna Commercial |
$3,103.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,143.99
|
| Rate for Payer: Cash Price |
$2,015.38
|
| Rate for Payer: Cigna Commercial |
$3,345.53
|
| Rate for Payer: First Health Commercial |
$3,829.22
|
| Rate for Payer: Humana Commercial |
$3,426.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,305.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,974.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,209.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,547.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,023.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,224.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,506.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,781.22
|
| Rate for Payer: PHCS Commercial |
$3,869.53
|
| Rate for Payer: United Healthcare All Payer |
$3,547.07
|
|
|
VARIZIG 125 UNIT/1.2 ML VL
|
Facility
|
OP
|
$4,030.76
|
|
|
Service Code
|
HCPCS 90396
|
| Hospital Charge Code |
25003878
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,386.18 |
| Max. Negotiated Rate |
$3,869.53 |
| Rate for Payer: Aetna Commercial |
$3,103.69
|
| Rate for Payer: Anthem Medicaid |
$1,386.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,359.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,143.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,303.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,185.86
|
| Rate for Payer: Cash Price |
$2,015.38
|
| Rate for Payer: Cash Price |
$2,015.38
|
| Rate for Payer: Cigna Commercial |
$3,345.53
|
| Rate for Payer: First Health Commercial |
$3,829.22
|
| Rate for Payer: Humana Commercial |
$3,426.15
|
| Rate for Payer: Humana KY Medicaid |
$1,386.18
|
| Rate for Payer: Humana Medicare Advantage |
$2,359.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,400.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,305.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,974.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,831.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,413.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,547.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,023.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,224.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,506.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,781.22
|
| Rate for Payer: PHCS Commercial |
$3,869.53
|
| Rate for Payer: United Healthcare All Payer |
$3,547.07
|
|
|
VASCADE VCS 5F
|
Facility
|
IP
|
$2,033.40
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.02 |
| Max. Negotiated Rate |
$1,952.06 |
| Rate for Payer: Aetna Commercial |
$1,565.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,586.05
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$1,687.72
|
| Rate for Payer: First Health Commercial |
$1,931.73
|
| Rate for Payer: Humana Commercial |
$1,728.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,525.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.05
|
| Rate for Payer: PHCS Commercial |
$1,952.06
|
| Rate for Payer: United Healthcare All Payer |
$1,789.39
|
|
|
VASCADE VCS 5F
|
Facility
|
OP
|
$2,033.40
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.02 |
| Max. Negotiated Rate |
$1,952.06 |
| Rate for Payer: Aetna Commercial |
$1,565.72
|
| Rate for Payer: Anthem Medicaid |
$699.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,586.05
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$1,687.72
|
| Rate for Payer: First Health Commercial |
$1,931.73
|
| Rate for Payer: Humana Commercial |
$1,728.39
|
| Rate for Payer: Humana KY Medicaid |
$699.29
|
| Rate for Payer: Kentucky WC Medicaid |
$706.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,525.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.05
|
| Rate for Payer: PHCS Commercial |
$1,952.06
|
| Rate for Payer: United Healthcare All Payer |
$1,789.39
|
|
|
VASCADE VCS 6/7F
|
Facility
|
OP
|
$2,033.40
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.02 |
| Max. Negotiated Rate |
$1,952.06 |
| Rate for Payer: Aetna Commercial |
$1,565.72
|
| Rate for Payer: Anthem Medicaid |
$699.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,586.05
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$1,687.72
|
| Rate for Payer: First Health Commercial |
$1,931.73
|
| Rate for Payer: Humana Commercial |
$1,728.39
|
| Rate for Payer: Humana KY Medicaid |
$699.29
|
| Rate for Payer: Kentucky WC Medicaid |
$706.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,525.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.05
|
| Rate for Payer: PHCS Commercial |
$1,952.06
|
| Rate for Payer: United Healthcare All Payer |
$1,789.39
|
|
|
VASCADE VCS 6/7F
|
Facility
|
IP
|
$2,033.40
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.02 |
| Max. Negotiated Rate |
$1,952.06 |
| Rate for Payer: Aetna Commercial |
$1,565.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,586.05
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$1,687.72
|
| Rate for Payer: First Health Commercial |
$1,931.73
|
| Rate for Payer: Humana Commercial |
$1,728.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,525.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,769.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.05
|
| Rate for Payer: PHCS Commercial |
$1,952.06
|
| Rate for Payer: United Healthcare All Payer |
$1,789.39
|
|
|
VASC EMBOLIZATION/OCC VENOUS
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 37241
|
| Hospital Charge Code |
76101564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.52 |
| Max. Negotiated Rate |
$5,515.96 |
| Rate for Payer: Ambetter Exchange |
$397.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$349.52
|
| Rate for Payer: Anthem Medicaid |
$3,377.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$397.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$397.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$477.50
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cigna Commercial |
$821.22
|
| Rate for Payer: Healthspan PPO |
$5,515.96
|
| Rate for Payer: Humana Medicaid |
$3,377.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$587.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$397.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$397.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,445.52
|
| Rate for Payer: Molina Healthcare Passport |
$3,377.96
|
| Rate for Payer: Multiplan PHCS |
$393.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$517.30
|
| Rate for Payer: UHCCP Medicaid |
$367.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,411.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$397.92
|
|
|
VASC EMBOLIZATION/OCC VENOUS
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
HCPCS 37241
|
| Hospital Charge Code |
76101564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.50 |
| Max. Negotiated Rate |
$628.80 |
| Rate for Payer: Aetna Commercial |
$504.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$510.90
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cigna Commercial |
$543.65
|
| Rate for Payer: First Health Commercial |
$622.25
|
| Rate for Payer: Humana Commercial |
$556.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$537.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$483.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$576.40
|
| Rate for Payer: Ohio Health Group HMO |
$491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$524.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$451.95
|
| Rate for Payer: PHCS Commercial |
$628.80
|
| Rate for Payer: United Healthcare All Payer |
$576.40
|
|
|
VASC EMBOLIZATION/OCC VENOUS
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
HCPCS 37241
|
| Hospital Charge Code |
76101564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.25 |
| Max. Negotiated Rate |
$14,669.84 |
| Rate for Payer: Aetna Commercial |
$504.35
|
| Rate for Payer: Anthem Medicaid |
$225.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$510.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cigna Commercial |
$543.65
|
| Rate for Payer: First Health Commercial |
$622.25
|
| Rate for Payer: Humana Commercial |
$556.75
|
| Rate for Payer: Humana KY Medicaid |
$225.25
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$227.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$537.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$483.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$229.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$576.40
|
| Rate for Payer: Ohio Health Group HMO |
$491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$524.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$451.95
|
| Rate for Payer: PHCS Commercial |
$628.80
|
| Rate for Payer: United Healthcare All Payer |
$576.40
|
|
