|
PACIFIC PLUS BALLOON 5*20*180
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem Medicaid |
$729.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Humana KY Medicaid |
$729.07
|
| Rate for Payer: Kentucky WC Medicaid |
$736.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$743.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
PACIFIC PLUS BALLOON 5*40*180
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem Medicaid |
$729.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Humana KY Medicaid |
$729.07
|
| Rate for Payer: Kentucky WC Medicaid |
$736.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$743.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
PACIFIC PLUS BALLOON 5*40*180
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
PACIFIC PLUS BALLOON 6*20*180
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem Medicaid |
$729.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Humana KY Medicaid |
$729.07
|
| Rate for Payer: Kentucky WC Medicaid |
$736.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$743.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
PACIFIC PLUS BALLOON 6*20*180
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
PACIFIC PLUS BALLOON 6*40*180
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
PACIFIC PLUS BALLOON 6*40*180
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem Medicaid |
$729.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Humana KY Medicaid |
$729.07
|
| Rate for Payer: Kentucky WC Medicaid |
$736.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$743.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
PACIFIC PLUS BALLOON 7*20*180
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem Medicaid |
$729.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Humana KY Medicaid |
$729.07
|
| Rate for Payer: Kentucky WC Medicaid |
$736.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$743.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
PACIFIC PLUS BALLOON 7*20*180
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
PACIFIC PLUS BALLOON 7*40*180
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem Medicaid |
$729.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Humana KY Medicaid |
$729.07
|
| Rate for Payer: Kentucky WC Medicaid |
$736.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$743.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
PACIFIC PLUS BALLOON 7*40*180
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.20
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
PACING CABLE SCREW IN FL-601-9
|
Facility
|
IP
|
$495.39
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$475.57 |
| Rate for Payer: Aetna Commercial |
$381.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.40
|
| Rate for Payer: Cash Price |
$247.70
|
| Rate for Payer: Cigna Commercial |
$411.17
|
| Rate for Payer: First Health Commercial |
$470.62
|
| Rate for Payer: Humana Commercial |
$421.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.94
|
| Rate for Payer: Ohio Health Group HMO |
$371.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.57
|
| Rate for Payer: PHCS Commercial |
$475.57
|
| Rate for Payer: United Healthcare All Payer |
$435.94
|
|
|
PACING CABLE SCREW IN FL-601-9
|
Facility
|
OP
|
$495.39
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$475.57 |
| Rate for Payer: Aetna Commercial |
$381.45
|
| Rate for Payer: Anthem Medicaid |
$170.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.40
|
| Rate for Payer: Cash Price |
$247.70
|
| Rate for Payer: Cigna Commercial |
$411.17
|
| Rate for Payer: First Health Commercial |
$470.62
|
| Rate for Payer: Humana Commercial |
$421.08
|
| Rate for Payer: Humana KY Medicaid |
$170.36
|
| Rate for Payer: Kentucky WC Medicaid |
$172.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.94
|
| Rate for Payer: Ohio Health Group HMO |
$371.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.57
|
| Rate for Payer: PHCS Commercial |
$475.57
|
| Rate for Payer: United Healthcare All Payer |
$435.94
|
|
|
PACING CABLE SCRW IN FL-601-97
|
Facility
|
OP
|
$479.82
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$62.38 |
| Max. Negotiated Rate |
$460.63 |
| Rate for Payer: Aetna Commercial |
$369.46
|
| Rate for Payer: Anthem Medicaid |
$165.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.26
|
| Rate for Payer: Cash Price |
$239.91
|
| Rate for Payer: Cigna Commercial |
$398.25
|
| Rate for Payer: First Health Commercial |
$455.83
|
| Rate for Payer: Humana Commercial |
$407.85
|
| Rate for Payer: Humana KY Medicaid |
$165.01
|
| Rate for Payer: Kentucky WC Medicaid |
$166.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.24
|
| Rate for Payer: Ohio Health Group HMO |
$359.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.74
|
| Rate for Payer: PHCS Commercial |
$460.63
|
| Rate for Payer: United Healthcare All Payer |
$422.24
|
|
|
PACING CABLE SCRW IN FL-601-97
|
Facility
|
IP
|
$479.82
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$62.38 |
| Max. Negotiated Rate |
$460.63 |
| Rate for Payer: Aetna Commercial |
$369.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.26
|
| Rate for Payer: Cash Price |
$239.91
|
| Rate for Payer: Cigna Commercial |
$398.25
|
| Rate for Payer: First Health Commercial |
$455.83
|
| Rate for Payer: Humana Commercial |
$407.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.24
|
| Rate for Payer: Ohio Health Group HMO |
$359.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.74
|
| Rate for Payer: PHCS Commercial |
$460.63
|
| Rate for Payer: United Healthcare All Payer |
$422.24
|
|
|
PACLITAXEL 1MG (FROM 100MG MDV
|
Facility
|
OP
|
$2.34
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
25004033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Anthem Medicaid |
$0.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.83
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna Commercial |
$1.94
|
| Rate for Payer: First Health Commercial |
$2.22
|
| Rate for Payer: Humana Commercial |
$1.99
|
| Rate for Payer: Humana KY Medicaid |
$0.80
|
| Rate for Payer: Kentucky WC Medicaid |
$0.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.06
|
| Rate for Payer: Ohio Health Group HMO |
$1.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.73
|
| Rate for Payer: PHCS Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Payer |
$2.06
|
|
|
PACLITAXEL 1MG (FROM 100MG MDV
|
Facility
|
IP
|
$2.34
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
25004033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.83
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna Commercial |
$1.94
|
| Rate for Payer: First Health Commercial |
$2.22
|
| Rate for Payer: Humana Commercial |
$1.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.06
|
| Rate for Payer: Ohio Health Group HMO |
$1.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.73
|
| Rate for Payer: PHCS Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Payer |
$2.06
|
|
|
PACLITAXEL 1MG (FROM 300MG MDV
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
25004034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Anthem Medicaid |
$0.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.40
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$1.49
|
| Rate for Payer: First Health Commercial |
$1.71
|
| Rate for Payer: Humana Commercial |
$1.53
|
| Rate for Payer: Humana KY Medicaid |
$0.62
|
| Rate for Payer: Kentucky WC Medicaid |
$0.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.58
|
| Rate for Payer: Ohio Health Group HMO |
$1.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.56
|
| Rate for Payer: PHCS Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Payer |
$1.58
|
|
|
PACLITAXEL 1MG (FROM 300MG MDV
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
25004034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.40
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$1.49
|
| Rate for Payer: First Health Commercial |
$1.71
|
| Rate for Payer: Humana Commercial |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.58
|
| Rate for Payer: Ohio Health Group HMO |
$1.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.56
|
| Rate for Payer: PHCS Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Payer |
$1.58
|
|
|
PACLITAXEL 1MG (FROM 30MG MDV)
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
25004032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Anthem Medicaid |
$0.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.40
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$1.49
|
| Rate for Payer: First Health Commercial |
$1.71
|
| Rate for Payer: Humana Commercial |
$1.53
|
| Rate for Payer: Humana KY Medicaid |
$0.62
|
| Rate for Payer: Kentucky WC Medicaid |
$0.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.58
|
| Rate for Payer: Ohio Health Group HMO |
$1.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.56
|
| Rate for Payer: PHCS Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Payer |
$1.58
|
|
|
PACLITAXEL 1MG (FROM 30MG MDV)
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
25004032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.40
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$1.49
|
| Rate for Payer: First Health Commercial |
$1.71
|
| Rate for Payer: Humana Commercial |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.58
|
| Rate for Payer: Ohio Health Group HMO |
$1.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.56
|
| Rate for Payer: PHCS Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Payer |
$1.58
|
|
|
PACU CRITICAL CARE ROOM RATE
|
Facility
|
IP
|
$3,432.00
|
|
| Hospital Charge Code |
20000004
|
|
Hospital Revenue Code
|
150
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
Padcev 0.25mg (20mg/10mLV)
|
Facility
|
OP
|
$15,309.05
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
25004010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$14,696.69 |
| Rate for Payer: Aetna Commercial |
$11,787.97
|
| Rate for Payer: Anthem Medicaid |
$5,264.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,941.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.29
|
| Rate for Payer: Cash Price |
$7,654.52
|
| Rate for Payer: Cash Price |
$7,654.52
|
| Rate for Payer: Cigna Commercial |
$12,706.51
|
| Rate for Payer: First Health Commercial |
$14,543.60
|
| Rate for Payer: Humana Commercial |
$13,012.69
|
| Rate for Payer: Humana KY Medicaid |
$5,264.78
|
| Rate for Payer: Humana Medicare Advantage |
$35.03
|
| Rate for Payer: Kentucky WC Medicaid |
$5,318.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,553.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,298.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,370.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,471.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,481.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,990.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,745.81
|
| Rate for Payer: PHCS Commercial |
$14,696.69
|
| Rate for Payer: United Healthcare All Payer |
$13,471.96
|
|
|
Padcev 0.25mg (20mg/10mLV)
|
Facility
|
IP
|
$15,309.05
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
25004010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,990.18 |
| Max. Negotiated Rate |
$14,696.69 |
| Rate for Payer: Aetna Commercial |
$11,787.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,941.06
|
| Rate for Payer: Cash Price |
$7,654.52
|
| Rate for Payer: Cigna Commercial |
$12,706.51
|
| Rate for Payer: First Health Commercial |
$14,543.60
|
| Rate for Payer: Humana Commercial |
$13,012.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,553.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,298.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,592.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,471.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,481.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,990.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,745.81
|
| Rate for Payer: PHCS Commercial |
$14,696.69
|
| Rate for Payer: United Healthcare All Payer |
$13,471.96
|
|
|
Padcev 0.25mg(30mg/10mLV)
|
Facility
|
OP
|
$22,963.58
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
25004011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$22,045.04 |
| Rate for Payer: Aetna Commercial |
$17,681.96
|
| Rate for Payer: Anthem Medicaid |
$7,897.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,911.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.29
|
| Rate for Payer: Cash Price |
$11,481.79
|
| Rate for Payer: Cash Price |
$11,481.79
|
| Rate for Payer: Cigna Commercial |
$19,059.77
|
| Rate for Payer: First Health Commercial |
$21,815.40
|
| Rate for Payer: Humana Commercial |
$19,519.04
|
| Rate for Payer: Humana KY Medicaid |
$7,897.18
|
| Rate for Payer: Humana Medicare Advantage |
$35.03
|
| Rate for Payer: Kentucky WC Medicaid |
$7,977.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,830.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,947.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,207.95
|
| Rate for Payer: Ohio Health Group HMO |
$17,222.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,592.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,985.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,118.71
|
| Rate for Payer: PHCS Commercial |
$22,045.04
|
| Rate for Payer: United Healthcare All Payer |
$20,207.95
|
|
