|
VENOVO 10F 20*120*80
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENOVO 10F 20*120*80
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENOVO 10F 20*40*80
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENOVO 10F 20*40*80
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENOVO 10F 20*80*80
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENOVO 10F 20*80*80
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
VENT 1ST DAY ASSIST/MANAGE
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
41000067
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$341.15 |
| Max. Negotiated Rate |
$952.32 |
| Rate for Payer: Aetna Commercial |
$763.84
|
| Rate for Payer: Anthem Medicaid |
$341.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$610.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$773.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$855.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$824.63
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna Commercial |
$823.36
|
| Rate for Payer: First Health Commercial |
$942.40
|
| Rate for Payer: Humana Commercial |
$843.20
|
| Rate for Payer: Humana KY Medicaid |
$341.15
|
| Rate for Payer: Humana Medicare Advantage |
$610.84
|
| Rate for Payer: Kentucky WC Medicaid |
$344.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$813.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$732.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$733.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$347.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$872.96
|
| Rate for Payer: Ohio Health Group HMO |
$744.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$793.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$684.48
|
| Rate for Payer: PHCS Commercial |
$952.32
|
| Rate for Payer: United Healthcare All Payer |
$872.96
|
|
|
VENT 1ST DAY ASSIST/MANAGE
|
Professional
|
Both
|
$992.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
41000067
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.19 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$140.02
|
| Rate for Payer: Ambetter Exchange |
$86.51
|
| Rate for Payer: Anthem Medicaid |
$68.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$103.81
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna Commercial |
$129.52
|
| Rate for Payer: Healthspan PPO |
$108.46
|
| Rate for Payer: Humana Medicaid |
$68.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.55
|
| Rate for Payer: Molina Healthcare Passport |
$68.19
|
| Rate for Payer: Multiplan PHCS |
$595.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.46
|
| Rate for Payer: UHCCP Medicaid |
$347.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.51
|
|
|
VENT 1ST DAY ASSIST/MANAGE
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
41000067
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$952.32 |
| Rate for Payer: Aetna Commercial |
$763.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$773.76
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cigna Commercial |
$823.36
|
| Rate for Payer: First Health Commercial |
$942.40
|
| Rate for Payer: Humana Commercial |
$843.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$813.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$732.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$872.96
|
| Rate for Payer: Ohio Health Group HMO |
$744.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$793.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$684.48
|
| Rate for Payer: PHCS Commercial |
$952.32
|
| Rate for Payer: United Healthcare All Payer |
$872.96
|
|
|
VENT 1ST DAY ASSIST/MANAGE(P
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
410P0067
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$140.02 |
| Rate for Payer: Aetna Commercial |
$140.02
|
| Rate for Payer: Ambetter Exchange |
$86.51
|
| Rate for Payer: Anthem Medicaid |
$68.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$103.81
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.52
|
| Rate for Payer: Healthspan PPO |
$108.46
|
| Rate for Payer: Humana Medicaid |
$68.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.55
|
| Rate for Payer: Molina Healthcare Passport |
$68.19
|
| Rate for Payer: Multiplan PHCS |
$93.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.46
|
| Rate for Payer: UHCCP Medicaid |
$54.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.51
|
|
|
VENT 1ST DAY ASSIST/MANAGE(T
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
410T0067
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$802.56 |
| Rate for Payer: Aetna Commercial |
$643.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.08
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$693.88
|
| Rate for Payer: First Health Commercial |
$794.20
|
| Rate for Payer: Humana Commercial |
$710.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.68
|
| Rate for Payer: Ohio Health Group HMO |
$627.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.84
|
| Rate for Payer: PHCS Commercial |
$802.56
|
| Rate for Payer: United Healthcare All Payer |
$735.68
|
|
|
VENT 1ST DAY ASSIST/MANAGE(T
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
410T0067
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$287.50 |
| Max. Negotiated Rate |
$855.18 |
| Rate for Payer: Aetna Commercial |
$643.72
|
| Rate for Payer: Anthem Medicaid |
$287.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$610.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$855.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$824.63
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$693.88
|
| Rate for Payer: First Health Commercial |
$794.20
|
| Rate for Payer: Humana Commercial |
$710.60
|
| Rate for Payer: Humana KY Medicaid |
$287.50
|
| Rate for Payer: Humana Medicare Advantage |
$610.84
|
| Rate for Payer: Kentucky WC Medicaid |
$290.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$733.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.68
|
| Rate for Payer: Ohio Health Group HMO |
$627.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.84
|
| Rate for Payer: PHCS Commercial |
$802.56
|
| Rate for Payer: United Healthcare All Payer |
$735.68
|
|
|
VENT ASSIST & MGNT
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 94004
|
| Hospital Charge Code |
41000101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.40
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.20
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
VENT ASSIST & MGNT
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 94004
|
| Hospital Charge Code |
41000101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$73.43 |
| Rate for Payer: Aetna Commercial |
$73.43
|
| Rate for Payer: Ambetter Exchange |
$44.41
|
| Rate for Payer: Anthem Medicaid |
$35.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$44.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$44.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$53.29
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$68.63
|
| Rate for Payer: Healthspan PPO |
$56.88
|
| Rate for Payer: Humana Medicaid |
$35.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$44.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.61
|
| Rate for Payer: Molina Healthcare Passport |
$35.89
|
| Rate for Payer: Multiplan PHCS |
$48.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$57.73
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.41
|
|
|
VENT ASSIST & MGNT
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 94004
|
| Hospital Charge Code |
41000101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem Medicaid |
$27.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.40
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Humana KY Medicaid |
$27.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.20
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
VENT ASSIST & MGNT(P
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 94004
|
| Hospital Charge Code |
410P0101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$73.43 |
| Rate for Payer: Aetna Commercial |
$73.43
|
| Rate for Payer: Ambetter Exchange |
$44.41
|
| Rate for Payer: Anthem Medicaid |
$35.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$44.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$44.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$53.29
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$68.63
|
| Rate for Payer: Healthspan PPO |
$56.88
|
| Rate for Payer: Humana Medicaid |
$35.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$44.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.61
|
| Rate for Payer: Molina Healthcare Passport |
$35.89
|
| Rate for Payer: Multiplan PHCS |
$48.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$57.73
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.41
|
|
|
VENTILATING TUBE REMOVAL
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
76102419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,376.29 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$3,081.54
|
| Rate for Payer: Anthem Medicaid |
$1,376.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$3,321.66
|
| Rate for Payer: First Health Commercial |
$3,801.90
|
| Rate for Payer: Humana Commercial |
$3,401.70
|
| Rate for Payer: Humana KY Medicaid |
$1,376.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,390.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,281.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,953.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,521.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,001.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,201.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,481.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,761.38
|
| Rate for Payer: PHCS Commercial |
$3,841.92
|
| Rate for Payer: United Healthcare All Payer |
$3,521.76
|
|
|
VENTILATING TUBE REMOVAL
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
76102419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,200.60 |
| Max. Negotiated Rate |
$3,841.92 |
| Rate for Payer: Aetna Commercial |
$3,081.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.56
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$3,321.66
|
| Rate for Payer: First Health Commercial |
$3,801.90
|
| Rate for Payer: Humana Commercial |
$3,401.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,281.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,953.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,521.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,001.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,201.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,481.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,761.38
|
| Rate for Payer: PHCS Commercial |
$3,841.92
|
| Rate for Payer: United Healthcare All Payer |
$3,521.76
|
|
|
VENTILATING TUBE REMOVAL
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
76102419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$2,401.20 |
| Rate for Payer: Aetna Commercial |
$90.45
|
| Rate for Payer: Ambetter Exchange |
$57.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$42.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$57.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$57.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$68.83
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$88.02
|
| Rate for Payer: Healthspan PPO |
$156.20
|
| Rate for Payer: Humana Medicaid |
$42.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$57.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.34
|
| Rate for Payer: Molina Healthcare Passport |
$42.49
|
| Rate for Payer: Multiplan PHCS |
$2,401.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.57
|
| Rate for Payer: UHCCP Medicaid |
$37.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$57.36
|
|
|
VENTILATING TUBE REMOVAL(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
761P2419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$156.20 |
| Rate for Payer: Aetna Commercial |
$90.45
|
| Rate for Payer: Ambetter Exchange |
$57.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$42.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$57.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$57.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$68.83
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$88.02
|
| Rate for Payer: Healthspan PPO |
$156.20
|
| Rate for Payer: Humana Medicaid |
$42.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$57.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.34
|
| Rate for Payer: Molina Healthcare Passport |
$42.49
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.57
|
| Rate for Payer: UHCCP Medicaid |
$37.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$57.36
|
|
|
VENTILATING TUBE REMOVAL(T
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
761T2419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,290.31 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem Medicaid |
$1,290.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Humana KY Medicaid |
$1,290.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,303.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,316.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
VENTILATING TUBE REMOVAL(T
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
761T2419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,125.60 |
| Max. Negotiated Rate |
$3,601.92 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
VENTOLIN (ALBUTEROL) UD/S 3ML
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
25001658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.07
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
VENTOLIN (ALBUTEROL) UD/S 3ML
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
25001658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.07
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
VENT SUBSEQUENT ASSIST/MANAGE
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
41000068
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$49.33 |
| Max. Negotiated Rate |
$553.80 |
| Rate for Payer: Aetna Commercial |
$101.03
|
| Rate for Payer: Ambetter Exchange |
$60.70
|
| Rate for Payer: Anthem Medicaid |
$49.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$60.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.84
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Cigna Commercial |
$94.21
|
| Rate for Payer: Healthspan PPO |
$78.26
|
| Rate for Payer: Humana Medicaid |
$49.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$81.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$60.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.32
|
| Rate for Payer: Molina Healthcare Passport |
$49.33
|
| Rate for Payer: Multiplan PHCS |
$553.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.91
|
| Rate for Payer: UHCCP Medicaid |
$323.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.70
|
|
