|
VASOTEC (ENALAPRIL) 2.5MG/1TAB
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 68682071001
|
| Hospital Charge Code |
25001655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: First Health Commercial |
$4.41
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.08
|
| Rate for Payer: Ohio Health Group HMO |
$3.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.20
|
| Rate for Payer: PHCS Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Payer |
$4.08
|
|
|
VASOTEC (ENALAPRIL) 5 5MG/1TAB
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 51672403801
|
| Hospital Charge Code |
25001656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
VASOTEC (ENALAPRIL) 5 5MG/1TAB
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 51672403801
|
| Hospital Charge Code |
25001656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
VAULT LOCK GLENOID LG
|
Facility
|
IP
|
$8,748.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.62 |
| Max. Negotiated Rate |
$8,398.80 |
| Rate for Payer: Aetna Commercial |
$6,736.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,824.02
|
| Rate for Payer: Cash Price |
$4,374.38
|
| Rate for Payer: Cigna Commercial |
$7,261.46
|
| Rate for Payer: First Health Commercial |
$8,311.31
|
| Rate for Payer: Humana Commercial |
$7,436.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,173.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,456.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,624.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,698.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,561.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,999.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,611.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,036.64
|
| Rate for Payer: PHCS Commercial |
$8,398.80
|
| Rate for Payer: United Healthcare All Payer |
$7,698.90
|
|
|
VAULT LOCK GLENOID LG
|
Facility
|
OP
|
$8,748.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.62 |
| Max. Negotiated Rate |
$8,398.80 |
| Rate for Payer: Aetna Commercial |
$6,736.54
|
| Rate for Payer: Anthem Medicaid |
$3,008.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,824.02
|
| Rate for Payer: Cash Price |
$4,374.38
|
| Rate for Payer: Cigna Commercial |
$7,261.46
|
| Rate for Payer: First Health Commercial |
$8,311.31
|
| Rate for Payer: Humana Commercial |
$7,436.44
|
| Rate for Payer: Humana KY Medicaid |
$3,008.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,039.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,173.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,456.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,624.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,069.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,698.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,561.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,999.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,611.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,036.64
|
| Rate for Payer: PHCS Commercial |
$8,398.80
|
| Rate for Payer: United Healthcare All Payer |
$7,698.90
|
|
|
VAULT LOCK GLENOID MD
|
Facility
|
IP
|
$8,748.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.62 |
| Max. Negotiated Rate |
$8,398.80 |
| Rate for Payer: Aetna Commercial |
$6,736.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,824.02
|
| Rate for Payer: Cash Price |
$4,374.38
|
| Rate for Payer: Cigna Commercial |
$7,261.46
|
| Rate for Payer: First Health Commercial |
$8,311.31
|
| Rate for Payer: Humana Commercial |
$7,436.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,173.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,456.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,624.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,698.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,561.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,999.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,611.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,036.64
|
| Rate for Payer: PHCS Commercial |
$8,398.80
|
| Rate for Payer: United Healthcare All Payer |
$7,698.90
|
|
|
VAULT LOCK GLENOID MD
|
Facility
|
OP
|
$8,748.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.62 |
| Max. Negotiated Rate |
$8,398.80 |
| Rate for Payer: Aetna Commercial |
$6,736.54
|
| Rate for Payer: Anthem Medicaid |
$3,008.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,824.02
|
| Rate for Payer: Cash Price |
$4,374.38
|
| Rate for Payer: Cigna Commercial |
$7,261.46
|
| Rate for Payer: First Health Commercial |
$8,311.31
|
| Rate for Payer: Humana Commercial |
$7,436.44
|
| Rate for Payer: Humana KY Medicaid |
$3,008.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,039.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,173.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,456.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,624.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,069.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,698.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,561.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,999.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,611.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,036.64
|
| Rate for Payer: PHCS Commercial |
$8,398.80
|
| Rate for Payer: United Healthcare All Payer |
$7,698.90
|
|
|
VAULT LOCK GLENOID SMALL
|
Facility
|
OP
|
$8,748.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.62 |
| Max. Negotiated Rate |
$8,398.80 |
| Rate for Payer: Aetna Commercial |
$6,736.54
|
| Rate for Payer: Anthem Medicaid |
$3,008.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,824.02
|
| Rate for Payer: Cash Price |
$4,374.38
|
| Rate for Payer: Cigna Commercial |
$7,261.46
|
| Rate for Payer: First Health Commercial |
$8,311.31
|
| Rate for Payer: Humana Commercial |
$7,436.44
|
| Rate for Payer: Humana KY Medicaid |
$3,008.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,039.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,173.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,456.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,624.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,069.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,698.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,561.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,999.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,611.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,036.64
|
| Rate for Payer: PHCS Commercial |
$8,398.80
|
| Rate for Payer: United Healthcare All Payer |
$7,698.90
|
|
|
VAULT LOCK GLENOID SMALL
|
Facility
|
IP
|
$8,748.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.62 |
| Max. Negotiated Rate |
$8,398.80 |
| Rate for Payer: Aetna Commercial |
$6,736.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,824.02
|
| Rate for Payer: Cash Price |
$4,374.38
|
| Rate for Payer: Cigna Commercial |
$7,261.46
|
| Rate for Payer: First Health Commercial |
$8,311.31
|
| Rate for Payer: Humana Commercial |
$7,436.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,173.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,456.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,624.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,698.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,561.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,999.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,611.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,036.64
|
| Rate for Payer: PHCS Commercial |
$8,398.80
|
| Rate for Payer: United Healthcare All Payer |
$7,698.90
|
|
|
VAULT LOCK GLENOID XLG
|
Facility
|
IP
|
$8,748.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.62 |
| Max. Negotiated Rate |
$8,398.80 |
| Rate for Payer: Aetna Commercial |
$6,736.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,824.02
|
| Rate for Payer: Cash Price |
$4,374.38
|
| Rate for Payer: Cigna Commercial |
$7,261.46
|
| Rate for Payer: First Health Commercial |
$8,311.31
|
| Rate for Payer: Humana Commercial |
$7,436.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,173.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,456.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,624.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,698.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,561.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,999.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,611.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,036.64
|
| Rate for Payer: PHCS Commercial |
$8,398.80
|
| Rate for Payer: United Healthcare All Payer |
$7,698.90
|
|
|
VAULT LOCK GLENOID XLG
|
Facility
|
OP
|
$8,748.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.62 |
| Max. Negotiated Rate |
$8,398.80 |
| Rate for Payer: Aetna Commercial |
$6,736.54
|
| Rate for Payer: Anthem Medicaid |
$3,008.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,824.02
|
| Rate for Payer: Cash Price |
$4,374.38
|
| Rate for Payer: Cigna Commercial |
$7,261.46
|
| Rate for Payer: First Health Commercial |
$8,311.31
|
| Rate for Payer: Humana Commercial |
$7,436.44
|
| Rate for Payer: Humana KY Medicaid |
$3,008.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,039.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,173.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,456.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,624.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,069.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,698.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,561.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,999.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,611.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,036.64
|
| Rate for Payer: PHCS Commercial |
$8,398.80
|
| Rate for Payer: United Healthcare All Payer |
$7,698.90
|
|
|
VAXCEL W/PASV PORT MINI 6FR
|
Facility
|
IP
|
$4,403.75
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,321.12 |
| Max. Negotiated Rate |
$4,227.60 |
| Rate for Payer: Aetna Commercial |
$3,390.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,434.93
|
| Rate for Payer: Cash Price |
$2,201.88
|
| Rate for Payer: Cigna Commercial |
$3,655.11
|
| Rate for Payer: First Health Commercial |
$4,183.56
|
| Rate for Payer: Humana Commercial |
$3,743.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,611.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,249.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,321.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,875.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,302.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,523.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,831.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.59
|
| Rate for Payer: PHCS Commercial |
$4,227.60
|
| Rate for Payer: United Healthcare All Payer |
$3,875.30
|
|
|
VAXCEL W/PASV PORT MINI 6FR
|
Facility
|
OP
|
$4,403.75
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,321.12 |
| Max. Negotiated Rate |
$4,227.60 |
| Rate for Payer: Aetna Commercial |
$3,390.89
|
| Rate for Payer: Anthem Medicaid |
$1,514.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,434.93
|
| Rate for Payer: Cash Price |
$2,201.88
|
| Rate for Payer: Cigna Commercial |
$3,655.11
|
| Rate for Payer: First Health Commercial |
$4,183.56
|
| Rate for Payer: Humana Commercial |
$3,743.19
|
| Rate for Payer: Humana KY Medicaid |
$1,514.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,529.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,611.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,249.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,321.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,875.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,302.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,523.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,831.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.59
|
| Rate for Payer: PHCS Commercial |
$4,227.60
|
| Rate for Payer: United Healthcare All Payer |
$3,875.30
|
|
|
VAXNEUVANCE (PCV15) VACCINE
|
Facility
|
OP
|
$663.61
|
|
|
Service Code
|
HCPCS 90671
|
| Hospital Charge Code |
25004286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$199.08 |
| Max. Negotiated Rate |
$637.07 |
| Rate for Payer: Aetna Commercial |
$510.98
|
| Rate for Payer: Anthem Medicaid |
$228.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$517.62
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$550.80
|
| Rate for Payer: First Health Commercial |
$630.43
|
| Rate for Payer: Humana Commercial |
$564.07
|
| Rate for Payer: Humana KY Medicaid |
$228.22
|
| Rate for Payer: Kentucky WC Medicaid |
$230.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$544.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$489.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$232.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$583.98
|
| Rate for Payer: Ohio Health Group HMO |
$497.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$530.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$457.89
|
| Rate for Payer: PHCS Commercial |
$637.07
|
| Rate for Payer: United Healthcare All Payer |
$583.98
|
|
|
VAXNEUVANCE (PCV15) VACCINE
|
Facility
|
IP
|
$663.61
|
|
|
Service Code
|
HCPCS 90671
|
| Hospital Charge Code |
25004286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$199.08 |
| Max. Negotiated Rate |
$637.07 |
| Rate for Payer: Aetna Commercial |
$510.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$517.62
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$550.80
|
| Rate for Payer: First Health Commercial |
$630.43
|
| Rate for Payer: Humana Commercial |
$564.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$544.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$489.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$583.98
|
| Rate for Payer: Ohio Health Group HMO |
$497.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$530.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$457.89
|
| Rate for Payer: PHCS Commercial |
$637.07
|
| Rate for Payer: United Healthcare All Payer |
$583.98
|
|
|
VBAC CARE AFTER DELIVERY
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 59614
|
| Hospital Charge Code |
76102614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$1,677.53 |
| Rate for Payer: Aetna Commercial |
$1,623.34
|
| Rate for Payer: Ambetter Exchange |
$1,119.04
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,119.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,119.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,342.85
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$1,497.28
|
| Rate for Payer: Healthspan PPO |
$1,178.25
|
| Rate for Payer: Humana Medicaid |
$900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,677.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,119.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.00
|
| Rate for Payer: Molina Healthcare Passport |
$900.00
|
| Rate for Payer: Multiplan PHCS |
$828.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,454.75
|
| Rate for Payer: UHCCP Medicaid |
$483.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,119.04
|
|
|
VBAC CARE AFTER DELIVERY
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
HCPCS 59614
|
| Hospital Charge Code |
76102614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Aetna Commercial |
$1,062.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,076.40
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: First Health Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial |
$1,173.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,131.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,018.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$414.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,214.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,200.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$952.20
|
| Rate for Payer: PHCS Commercial |
$1,324.80
|
| Rate for Payer: United Healthcare All Payer |
$1,214.40
|
|
|
VBAC CARE AFTER DELIVERY
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 59614
|
| Hospital Charge Code |
761P2614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$1,677.53 |
| Rate for Payer: Aetna Commercial |
$1,623.34
|
| Rate for Payer: Ambetter Exchange |
$1,119.04
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,119.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,119.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,342.85
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$1,497.28
|
| Rate for Payer: Healthspan PPO |
$1,178.25
|
| Rate for Payer: Humana Medicaid |
$900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,677.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,119.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.00
|
| Rate for Payer: Molina Healthcare Passport |
$900.00
|
| Rate for Payer: Multiplan PHCS |
$828.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,454.75
|
| Rate for Payer: UHCCP Medicaid |
$483.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,119.04
|
|
|
VBAC CARE AFTER DELIVERY
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
HCPCS 59614
|
| Hospital Charge Code |
76102614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Aetna Commercial |
$1,062.60
|
| Rate for Payer: Anthem Medicaid |
$474.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,076.40
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: First Health Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial |
$1,173.00
|
| Rate for Payer: Humana KY Medicaid |
$474.58
|
| Rate for Payer: Kentucky WC Medicaid |
$479.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,131.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,018.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$414.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$484.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,214.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,200.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$952.20
|
| Rate for Payer: PHCS Commercial |
$1,324.80
|
| Rate for Payer: United Healthcare All Payer |
$1,214.40
|
|
|
VBAC DELIVERY ONLY
|
Facility
|
OP
|
$5,931.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
72000025
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,039.67 |
| Max. Negotiated Rate |
$5,693.76 |
| Rate for Payer: Aetna Commercial |
$4,566.87
|
| Rate for Payer: Anthem Medicaid |
$2,039.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,626.18
|
| 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 |
$2,965.50
|
| Rate for Payer: Cash Price |
$2,965.50
|
| Rate for Payer: Cigna Commercial |
$4,922.73
|
| Rate for Payer: First Health Commercial |
$5,634.45
|
| Rate for Payer: Humana Commercial |
$5,041.35
|
| Rate for Payer: Humana KY Medicaid |
$2,039.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,060.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,863.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,377.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,080.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,219.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,159.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,092.39
|
| Rate for Payer: PHCS Commercial |
$5,693.76
|
| Rate for Payer: United Healthcare All Payer |
$5,219.28
|
|
|
VBAC DELIVERY ONLY
|
Professional
|
Both
|
$5,931.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
72000025
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$866.84 |
| Max. Negotiated Rate |
$3,558.60 |
| Rate for Payer: Aetna Commercial |
$1,454.14
|
| Rate for Payer: Ambetter Exchange |
$866.84
|
| Rate for Payer: Anthem Medicaid |
$870.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$866.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$866.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,040.21
|
| Rate for Payer: Cash Price |
$2,965.50
|
| Rate for Payer: Cash Price |
$2,965.50
|
| Rate for Payer: Cigna Commercial |
$1,345.28
|
| Rate for Payer: Healthspan PPO |
$1,055.45
|
| Rate for Payer: Humana Medicaid |
$870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,526.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$866.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$866.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$887.40
|
| Rate for Payer: Molina Healthcare Passport |
$870.00
|
| Rate for Payer: Multiplan PHCS |
$3,558.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,126.89
|
| Rate for Payer: UHCCP Medicaid |
$2,075.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$878.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$866.84
|
|
|
VBAC DELIVERY ONLY
|
Facility
|
IP
|
$5,931.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
72000025
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,779.30 |
| Max. Negotiated Rate |
$5,693.76 |
| Rate for Payer: Aetna Commercial |
$4,566.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,626.18
|
| Rate for Payer: Cash Price |
$2,965.50
|
| Rate for Payer: Cigna Commercial |
$4,922.73
|
| Rate for Payer: First Health Commercial |
$5,634.45
|
| Rate for Payer: Humana Commercial |
$5,041.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,863.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,377.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,779.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,219.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,159.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,092.39
|
| Rate for Payer: PHCS Commercial |
$5,693.76
|
| Rate for Payer: United Healthcare All Payer |
$5,219.28
|
|
|
VBAC DELIVERY ONLY(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
720P0025
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$1,526.51 |
| Rate for Payer: Aetna Commercial |
$1,454.14
|
| Rate for Payer: Ambetter Exchange |
$866.84
|
| Rate for Payer: Anthem Medicaid |
$870.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$866.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$866.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,040.21
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,345.28
|
| Rate for Payer: Healthspan PPO |
$1,055.45
|
| Rate for Payer: Humana Medicaid |
$870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,526.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$866.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$866.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$887.40
|
| Rate for Payer: Molina Healthcare Passport |
$870.00
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,126.89
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$878.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$866.84
|
|
|
VBAC DELIVERY ONLY(T
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
720T0025
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,283.09 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem Medicaid |
$1,283.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| 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 |
$1,865.50
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Humana KY Medicaid |
$1,283.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,574.39
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
VBAC DELIVERY ONLY(T
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
720T0025
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,119.30 |
| Max. Negotiated Rate |
$3,581.76 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,574.39
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
