|
VELTASSA 8.4 GM PACKET
|
Facility
|
IP
|
$82.10
|
|
|
Service Code
|
NDC 53436008401
|
| Hospital Charge Code |
25003567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.63 |
| Max. Negotiated Rate |
$78.82 |
| Rate for Payer: Aetna Commercial |
$63.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.04
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cigna Commercial |
$68.14
|
| Rate for Payer: First Health Commercial |
$78.00
|
| Rate for Payer: Humana Commercial |
$69.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.25
|
| Rate for Payer: Ohio Health Group HMO |
$61.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.65
|
| Rate for Payer: PHCS Commercial |
$78.82
|
| Rate for Payer: United Healthcare All Payer |
$72.25
|
|
|
VENIPUNCTURE
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$9.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.09
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$9.09
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Kentucky WC Medicaid |
$9.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
VENIPUNCTURE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$13.80 |
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Ambetter Exchange |
$9.09
|
| Rate for Payer: Anthem Medicaid |
$8.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$9.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$9.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.91
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$4.96
|
| Rate for Payer: Healthspan PPO |
$3.84
|
| Rate for Payer: Humana Medicaid |
$8.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.62
|
| Rate for Payer: Molina Healthcare Passport |
$8.45
|
| Rate for Payer: Multiplan PHCS |
$13.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.82
|
| Rate for Payer: UHCCP Medicaid |
$8.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.09
|
|
|
VENIPUNCTURE
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.47
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
VEN MECHNL THRMBC REPEAT TX
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 37188
|
| Hospital Charge Code |
76101529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$962.92 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
VEN MECHNL THRMBC REPEAT TX
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 37188
|
| Hospital Charge Code |
76101529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
VEN MECHNL THRMBC REPEAT TX
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 37188
|
| Hospital Charge Code |
76101529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.19 |
| Max. Negotiated Rate |
$2,275.48 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Ambetter Exchange |
$263.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$215.19
|
| Rate for Payer: Anthem Medicaid |
$1,764.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$263.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$263.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$316.30
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$448.50
|
| Rate for Payer: Healthspan PPO |
$2,275.48
|
| Rate for Payer: Humana Medicaid |
$1,764.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$263.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$263.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,800.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,764.83
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$342.65
|
| Rate for Payer: UHCCP Medicaid |
$225.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,782.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$263.58
|
|
|
VEN MECHNL THRMBC REPEAT TX(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 37188
|
| Hospital Charge Code |
761P1529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.19 |
| Max. Negotiated Rate |
$2,275.48 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Ambetter Exchange |
$263.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$215.19
|
| Rate for Payer: Anthem Medicaid |
$1,764.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$263.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$263.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$316.30
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$448.50
|
| Rate for Payer: Healthspan PPO |
$2,275.48
|
| Rate for Payer: Humana Medicaid |
$1,764.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$263.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$263.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,800.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,764.83
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$342.65
|
| Rate for Payer: UHCCP Medicaid |
$225.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,782.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$263.58
|
|
|
VENOFER 1mg (200mg SDV)
|
Facility
|
IP
|
$667.24
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
25004357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.17 |
| Max. Negotiated Rate |
$640.55 |
| Rate for Payer: Aetna Commercial |
$513.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$520.45
|
| Rate for Payer: Cash Price |
$333.62
|
| Rate for Payer: Cigna Commercial |
$553.81
|
| Rate for Payer: First Health Commercial |
$633.88
|
| Rate for Payer: Humana Commercial |
$567.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$547.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$587.17
|
| Rate for Payer: Ohio Health Group HMO |
$500.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$533.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$460.40
|
| Rate for Payer: PHCS Commercial |
$640.55
|
| Rate for Payer: United Healthcare All Payer |
$587.17
|
|
|
VENOFER 1mg (200mg SDV)
|
Facility
|
OP
|
$667.24
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
25004357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.17 |
| Max. Negotiated Rate |
$640.55 |
| Rate for Payer: Aetna Commercial |
$513.77
|
| Rate for Payer: Anthem Medicaid |
$229.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$520.45
|
| Rate for Payer: Cash Price |
$333.62
|
| Rate for Payer: Cigna Commercial |
$553.81
|
| Rate for Payer: First Health Commercial |
$633.88
|
| Rate for Payer: Humana Commercial |
$567.15
|
| Rate for Payer: Humana KY Medicaid |
$229.46
|
| Rate for Payer: Kentucky WC Medicaid |
$231.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$547.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$234.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$587.17
|
| Rate for Payer: Ohio Health Group HMO |
$500.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$533.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$460.40
|
| Rate for Payer: PHCS Commercial |
$640.55
|
| Rate for Payer: United Healthcare All Payer |
$587.17
|
|
|
VENOFERIRON SUC(1 MG)100MG/5ML
|
Facility
|
IP
|
$333.65
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
25002163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.09 |
| Max. Negotiated Rate |
$320.30 |
| Rate for Payer: Aetna Commercial |
$256.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.25
|
| Rate for Payer: Cash Price |
$166.82
|
| Rate for Payer: Cigna Commercial |
$276.93
|
| Rate for Payer: First Health Commercial |
$316.97
|
| Rate for Payer: Humana Commercial |
$283.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.61
|
| Rate for Payer: Ohio Health Group HMO |
$250.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.22
|
| Rate for Payer: PHCS Commercial |
$320.30
|
| Rate for Payer: United Healthcare All Payer |
$293.61
|
|
|
VENOFERIRON SUC(1 MG)100MG/5ML
|
Facility
|
OP
|
$333.65
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
25002163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.09 |
| Max. Negotiated Rate |
$320.30 |
| Rate for Payer: Aetna Commercial |
$256.91
|
| Rate for Payer: Anthem Medicaid |
$114.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.25
|
| Rate for Payer: Cash Price |
$166.82
|
| Rate for Payer: Cigna Commercial |
$276.93
|
| Rate for Payer: First Health Commercial |
$316.97
|
| Rate for Payer: Humana Commercial |
$283.60
|
| Rate for Payer: Humana KY Medicaid |
$114.74
|
| Rate for Payer: Kentucky WC Medicaid |
$115.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.61
|
| Rate for Payer: Ohio Health Group HMO |
$250.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.22
|
| Rate for Payer: PHCS Commercial |
$320.30
|
| Rate for Payer: United Healthcare All Payer |
$293.61
|
|
|
VENOGRAM - EXTREMITY - BILAT
|
Facility
|
IP
|
$1,864.00
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
32000166
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$559.20 |
| Max. Negotiated Rate |
$1,789.44 |
| Rate for Payer: Aetna Commercial |
$1,435.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,453.92
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cigna Commercial |
$1,547.12
|
| Rate for Payer: First Health Commercial |
$1,770.80
|
| Rate for Payer: Humana Commercial |
$1,584.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,528.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,375.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,640.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,491.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,621.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.16
|
| Rate for Payer: PHCS Commercial |
$1,789.44
|
| Rate for Payer: United Healthcare All Payer |
$1,640.32
|
|
|
VENOGRAM - EXTREMITY - BILAT
|
Facility
|
OP
|
$1,864.00
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
32000166
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$641.03 |
| Max. Negotiated Rate |
$2,009.49 |
| Rate for Payer: Aetna Commercial |
$1,435.28
|
| Rate for Payer: Anthem Medicaid |
$641.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,453.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cigna Commercial |
$1,547.12
|
| Rate for Payer: First Health Commercial |
$1,770.80
|
| Rate for Payer: Humana Commercial |
$1,584.40
|
| Rate for Payer: Humana KY Medicaid |
$641.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$647.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,528.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,375.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$653.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,640.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,491.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,621.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.16
|
| Rate for Payer: PHCS Commercial |
$1,789.44
|
| Rate for Payer: United Healthcare All Payer |
$1,640.32
|
|
|
VENOGRAM - EXTREMITY - BILAT
|
Professional
|
Both
|
$1,864.00
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
32000166
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$67.61 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$221.91
|
| Rate for Payer: Ambetter Exchange |
$122.09
|
| Rate for Payer: Anthem Medicaid |
$85.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.51
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cigna Commercial |
$180.37
|
| Rate for Payer: Healthspan PPO |
$207.93
|
| Rate for Payer: Humana Medicaid |
$85.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$67.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.13
|
| Rate for Payer: Molina Healthcare Passport |
$85.42
|
| Rate for Payer: Multiplan PHCS |
$1,118.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.72
|
| Rate for Payer: UHCCP Medicaid |
$652.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.09
|
|
|
VENOGRAM - EXTREMITY - BILAT(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
320P0166
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$67.61 |
| Max. Negotiated Rate |
$221.91 |
| Rate for Payer: Aetna Commercial |
$221.91
|
| Rate for Payer: Ambetter Exchange |
$122.09
|
| Rate for Payer: Anthem Medicaid |
$85.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.51
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$180.37
|
| Rate for Payer: Healthspan PPO |
$207.93
|
| Rate for Payer: Humana Medicaid |
$85.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$67.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.13
|
| Rate for Payer: Molina Healthcare Passport |
$85.42
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.72
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.09
|
|
|
VENOGRAM - EXTREMITY - BILAT(T
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
320T0166
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$537.86 |
| Max. Negotiated Rate |
$2,009.49 |
| Rate for Payer: Aetna Commercial |
$1,204.28
|
| Rate for Payer: Anthem Medicaid |
$537.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna Commercial |
$1,298.12
|
| Rate for Payer: First Health Commercial |
$1,485.80
|
| Rate for Payer: Humana Commercial |
$1,329.40
|
| Rate for Payer: Humana KY Medicaid |
$537.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$543.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,282.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$548.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,376.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,360.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.16
|
| Rate for Payer: PHCS Commercial |
$1,501.44
|
| Rate for Payer: United Healthcare All Payer |
$1,376.32
|
|
|
VENOGRAM - EXTREMITY - BILAT(T
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
320T0166
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$469.20 |
| Max. Negotiated Rate |
$1,501.44 |
| Rate for Payer: Aetna Commercial |
$1,204.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.92
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna Commercial |
$1,298.12
|
| Rate for Payer: First Health Commercial |
$1,485.80
|
| Rate for Payer: Humana Commercial |
$1,329.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,282.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,376.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,360.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.16
|
| Rate for Payer: PHCS Commercial |
$1,501.44
|
| Rate for Payer: United Healthcare All Payer |
$1,376.32
|
|
|
VENOGRAM - EXTREMITY - UNILA(P
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
320P0165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$180.09 |
| Rate for Payer: Aetna Commercial |
$180.09
|
| Rate for Payer: Ambetter Exchange |
$97.05
|
| Rate for Payer: Anthem Medicaid |
$55.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$97.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$97.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$116.46
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$131.64
|
| Rate for Payer: Healthspan PPO |
$168.75
|
| Rate for Payer: Humana Medicaid |
$55.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$97.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.06
|
| Rate for Payer: Molina Healthcare Passport |
$55.94
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.17
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$97.05
|
|
|
VENOGRAM - EXTREMITY - UNILA(T
|
Facility
|
OP
|
$1,529.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
320T0165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$525.82 |
| Max. Negotiated Rate |
$2,009.49 |
| Rate for Payer: Aetna Commercial |
$1,177.33
|
| Rate for Payer: Anthem Medicaid |
$525.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,192.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$764.50
|
| Rate for Payer: Cash Price |
$764.50
|
| Rate for Payer: Cigna Commercial |
$1,269.07
|
| Rate for Payer: First Health Commercial |
$1,452.55
|
| Rate for Payer: Humana Commercial |
$1,299.65
|
| Rate for Payer: Humana KY Medicaid |
$525.82
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$531.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,253.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,128.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$536.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,345.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,146.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,223.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,330.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.01
|
| Rate for Payer: PHCS Commercial |
$1,467.84
|
| Rate for Payer: United Healthcare All Payer |
$1,345.52
|
|
|
VENOGRAM - EXTREMITY - UNILA(T
|
Facility
|
IP
|
$1,529.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
320T0165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$458.70 |
| Max. Negotiated Rate |
$1,467.84 |
| Rate for Payer: Aetna Commercial |
$1,177.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,192.62
|
| Rate for Payer: Cash Price |
$764.50
|
| Rate for Payer: Cigna Commercial |
$1,269.07
|
| Rate for Payer: First Health Commercial |
$1,452.55
|
| Rate for Payer: Humana Commercial |
$1,299.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,253.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,128.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$458.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,345.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,146.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,223.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,330.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.01
|
| Rate for Payer: PHCS Commercial |
$1,467.84
|
| Rate for Payer: United Healthcare All Payer |
$1,345.52
|
|
|
VENOGRAM - EXTREMITY - UNILAT
|
Professional
|
Both
|
$1,659.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$995.40 |
| Rate for Payer: Aetna Commercial |
$180.09
|
| Rate for Payer: Ambetter Exchange |
$97.05
|
| Rate for Payer: Anthem Medicaid |
$55.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$97.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$97.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$116.46
|
| Rate for Payer: Cash Price |
$829.50
|
| Rate for Payer: Cash Price |
$829.50
|
| Rate for Payer: Cigna Commercial |
$131.64
|
| Rate for Payer: Healthspan PPO |
$168.75
|
| Rate for Payer: Humana Medicaid |
$55.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$97.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.06
|
| Rate for Payer: Molina Healthcare Passport |
$55.94
|
| Rate for Payer: Multiplan PHCS |
$995.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.17
|
| Rate for Payer: UHCCP Medicaid |
$580.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$97.05
|
|
|
VENOGRAM - EXTREMITY - UNILAT
|
Facility
|
IP
|
$1,659.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$497.70 |
| Max. Negotiated Rate |
$1,592.64 |
| Rate for Payer: Aetna Commercial |
$1,277.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,294.02
|
| Rate for Payer: Cash Price |
$829.50
|
| Rate for Payer: Cigna Commercial |
$1,376.97
|
| Rate for Payer: First Health Commercial |
$1,576.05
|
| Rate for Payer: Humana Commercial |
$1,410.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,360.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,224.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$497.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,459.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,244.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,327.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,443.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,144.71
|
| Rate for Payer: PHCS Commercial |
$1,592.64
|
| Rate for Payer: United Healthcare All Payer |
$1,459.92
|
|
|
VENOGRAM - EXTREMITY - UNILAT
|
Facility
|
OP
|
$1,659.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$570.53 |
| Max. Negotiated Rate |
$2,009.49 |
| Rate for Payer: Aetna Commercial |
$1,277.43
|
| Rate for Payer: Anthem Medicaid |
$570.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,294.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$829.50
|
| Rate for Payer: Cash Price |
$829.50
|
| Rate for Payer: Cigna Commercial |
$1,376.97
|
| Rate for Payer: First Health Commercial |
$1,576.05
|
| Rate for Payer: Humana Commercial |
$1,410.15
|
| Rate for Payer: Humana KY Medicaid |
$570.53
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$576.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,360.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,224.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$581.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,459.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,244.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,327.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,443.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,144.71
|
| Rate for Payer: PHCS Commercial |
$1,592.64
|
| Rate for Payer: United Healthcare All Payer |
$1,459.92
|
|
|
VENOGRAPHY ADRENAL UNIL SELEC
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75840
|
| Hospital Charge Code |
32000171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,536.20 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem Medicaid |
$1,536.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Humana KY Medicaid |
$1,536.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,573.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,886.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,082.23
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
