|
VENT SUBSEQUENT ASSIST/MANAGE
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
41000068
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$317.42 |
| Max. Negotiated Rate |
$886.08 |
| Rate for Payer: Aetna Commercial |
$710.71
|
| Rate for Payer: Anthem Medicaid |
$317.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$610.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$719.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$855.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$824.63
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Cigna Commercial |
$766.09
|
| Rate for Payer: First Health Commercial |
$876.85
|
| Rate for Payer: Humana Commercial |
$784.55
|
| Rate for Payer: Humana KY Medicaid |
$317.42
|
| Rate for Payer: Humana Medicare Advantage |
$610.84
|
| Rate for Payer: Kentucky WC Medicaid |
$320.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$756.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$681.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$733.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$323.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$812.24
|
| Rate for Payer: Ohio Health Group HMO |
$692.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$803.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$636.87
|
| Rate for Payer: PHCS Commercial |
$886.08
|
| Rate for Payer: United Healthcare All Payer |
$812.24
|
|
|
VENT SUBSEQUENT ASSIST/MANAGE
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
41000068
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$276.90 |
| Max. Negotiated Rate |
$886.08 |
| Rate for Payer: Aetna Commercial |
$710.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$719.94
|
| Rate for Payer: Cash Price |
$461.50
|
| Rate for Payer: Cigna Commercial |
$766.09
|
| Rate for Payer: First Health Commercial |
$876.85
|
| Rate for Payer: Humana Commercial |
$784.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$756.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$681.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$812.24
|
| Rate for Payer: Ohio Health Group HMO |
$692.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$803.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$636.87
|
| Rate for Payer: PHCS Commercial |
$886.08
|
| Rate for Payer: United Healthcare All Payer |
$812.24
|
|
|
VENT SUBSEQUENT ASSIST/MANAG(P
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
410P0068
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$101.03 |
| 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 |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| 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 |
$69.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.91
|
| Rate for Payer: UHCCP Medicaid |
$40.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.70
|
|
|
VENT SUBSEQUENT ASSIST/MANAG(T
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
410T0068
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$277.87 |
| Max. Negotiated Rate |
$855.18 |
| Rate for Payer: Aetna Commercial |
$622.16
|
| Rate for Payer: Anthem Medicaid |
$277.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$610.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$630.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$855.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$824.63
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cigna Commercial |
$670.64
|
| Rate for Payer: First Health Commercial |
$767.60
|
| Rate for Payer: Humana Commercial |
$686.80
|
| Rate for Payer: Humana KY Medicaid |
$277.87
|
| Rate for Payer: Humana Medicare Advantage |
$610.84
|
| Rate for Payer: Kentucky WC Medicaid |
$280.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$596.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$733.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.04
|
| Rate for Payer: Ohio Health Group HMO |
$606.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.52
|
| Rate for Payer: PHCS Commercial |
$775.68
|
| Rate for Payer: United Healthcare All Payer |
$711.04
|
|
|
VENT SUBSEQUENT ASSIST/MANAG(T
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
410T0068
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$242.40 |
| Max. Negotiated Rate |
$775.68 |
| Rate for Payer: Aetna Commercial |
$622.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$630.24
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cigna Commercial |
$670.64
|
| Rate for Payer: First Health Commercial |
$767.60
|
| Rate for Payer: Humana Commercial |
$686.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$596.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.04
|
| Rate for Payer: Ohio Health Group HMO |
$606.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.52
|
| Rate for Payer: PHCS Commercial |
$775.68
|
| Rate for Payer: United Healthcare All Payer |
$711.04
|
|
|
VENTURE CATH OTW
|
Facility
|
IP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
VENTURE CATH OTW
|
Facility
|
OP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem Medicaid |
$1,607.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Humana KY Medicaid |
$1,607.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
VENTURE CATH RX
|
Facility
|
IP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
VENTURE CATH RX
|
Facility
|
OP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem Medicaid |
$1,607.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Humana KY Medicaid |
$1,607.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
VERAPAMIL IC KIT
|
Facility
|
IP
|
$191.50
|
|
|
Service Code
|
NDC 70069027105
|
| Hospital Charge Code |
25003568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.45 |
| Max. Negotiated Rate |
$183.84 |
| Rate for Payer: Aetna Commercial |
$147.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.37
|
| Rate for Payer: Cash Price |
$95.75
|
| Rate for Payer: Cigna Commercial |
$158.94
|
| Rate for Payer: First Health Commercial |
$181.93
|
| Rate for Payer: Humana Commercial |
$162.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.52
|
| Rate for Payer: Ohio Health Group HMO |
$143.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.13
|
| Rate for Payer: PHCS Commercial |
$183.84
|
| Rate for Payer: United Healthcare All Payer |
$168.52
|
|
|
VERAPAMIL IC KIT
|
Facility
|
OP
|
$191.50
|
|
|
Service Code
|
NDC 70069027105
|
| Hospital Charge Code |
25003568
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.45 |
| Max. Negotiated Rate |
$183.84 |
| Rate for Payer: Aetna Commercial |
$147.46
|
| Rate for Payer: Anthem Medicaid |
$65.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.37
|
| Rate for Payer: Cash Price |
$95.75
|
| Rate for Payer: Cigna Commercial |
$158.94
|
| Rate for Payer: First Health Commercial |
$181.93
|
| Rate for Payer: Humana Commercial |
$162.78
|
| Rate for Payer: Humana KY Medicaid |
$65.86
|
| Rate for Payer: Kentucky WC Medicaid |
$66.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.52
|
| Rate for Payer: Ohio Health Group HMO |
$143.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.13
|
| Rate for Payer: PHCS Commercial |
$183.84
|
| Rate for Payer: United Healthcare All Payer |
$168.52
|
|
|
VERI-FLEX STENT 2.75*32
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
VERI-FLEX STENT 2.75*32
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
VERI-FLEX STENT 3*32
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
VERI-FLEX STENT 3*32
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
VERI-FLEX STENT 3.5*32
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
VERI-FLEX STENT 3.5*32
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
VERI-FLEX STENT 4*32
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
VERI-FLEX STENT 4*32
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
VERI-FLEX STENT 4.5*32
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
VERI-FLEX STENT 4.5*32
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
VERI-FLEX STENT 5*32
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
VERI-FLEX STENT 5*32
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
VERIFY NOW PRU TEST
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
30000615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem Medicaid |
$24.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.91
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Humana KY Medicaid |
$24.91
|
| Rate for Payer: Humana Medicare Advantage |
$24.91
|
| Rate for Payer: Kentucky WC Medicaid |
$25.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.32
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
VERIFY NOW PRU TEST
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
30000615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.78
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.32
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
