|
Padcev 0.25mg(30mg/10mLV)
|
Facility
|
IP
|
$22,963.58
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
25004011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,985.27 |
| Max. Negotiated Rate |
$22,045.04 |
| Rate for Payer: Aetna Commercial |
$17,681.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,911.59
|
| 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: 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 |
$6,889.07
|
| 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
|
|
|
PAD REHAB PER SESSION
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 93668
|
| Hospital Charge Code |
48000057
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem Medicaid |
$32.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Humana KY Medicaid |
$32.33
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$32.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.14
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
PAD REHAB PER SESSION
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 93668
|
| Hospital Charge Code |
48000057
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.32
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.14
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
PAIN EASE 116mL
|
Facility
|
OP
|
$1.82
|
|
|
Service Code
|
NDC 386000803
|
| Hospital Charge Code |
25003336
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Anthem Medicaid |
$0.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.42
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna Commercial |
$1.51
|
| Rate for Payer: First Health Commercial |
$1.73
|
| Rate for Payer: Humana Commercial |
$1.55
|
| Rate for Payer: Humana KY Medicaid |
$0.63
|
| Rate for Payer: Kentucky WC Medicaid |
$0.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.60
|
| Rate for Payer: Ohio Health Group HMO |
$1.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.56
|
| Rate for Payer: PHCS Commercial |
$1.75
|
| Rate for Payer: United Healthcare All Payer |
$1.60
|
|
|
PAIN EASE 116mL
|
Facility
|
IP
|
$1.82
|
|
|
Service Code
|
NDC 386000803
|
| Hospital Charge Code |
25003336
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.42
|
| Rate for Payer: Cash Price |
$0.91
|
| Rate for Payer: Cigna Commercial |
$1.51
|
| Rate for Payer: First Health Commercial |
$1.73
|
| Rate for Payer: Humana Commercial |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.60
|
| Rate for Payer: Ohio Health Group HMO |
$1.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.56
|
| Rate for Payer: PHCS Commercial |
$1.75
|
| Rate for Payer: United Healthcare All Payer |
$1.60
|
|
|
PAIN EASE 30mL
|
Facility
|
IP
|
$3.50
|
|
|
Service Code
|
NDC 386000804
|
| Hospital Charge Code |
25004386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.73
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.90
|
| Rate for Payer: First Health Commercial |
$3.32
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.08
|
| Rate for Payer: Ohio Health Group HMO |
$2.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.08
|
| Rate for Payer: PHCS Commercial |
$3.36
|
| Rate for Payer: United Healthcare All Payer |
$3.08
|
|
|
PAIN EASE 30mL
|
Facility
|
OP
|
$3.50
|
|
|
Service Code
|
NDC 386000804
|
| Hospital Charge Code |
25004386
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem Medicaid |
$1.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.73
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.90
|
| Rate for Payer: First Health Commercial |
$3.32
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Humana KY Medicaid |
$1.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.08
|
| Rate for Payer: Ohio Health Group HMO |
$2.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.08
|
| Rate for Payer: PHCS Commercial |
$3.36
|
| Rate for Payer: United Healthcare All Payer |
$3.08
|
|
|
PAIR/CUT BEN HYPERKER LES 4+
|
Facility
|
OP
|
$402.26
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.29 |
| Max. Negotiated Rate |
$386.17 |
| Rate for Payer: Aetna Commercial |
$309.74
|
| Rate for Payer: Anthem Medicaid |
$138.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$201.13
|
| Rate for Payer: Cash Price |
$201.13
|
| Rate for Payer: Cigna Commercial |
$333.88
|
| Rate for Payer: First Health Commercial |
$382.15
|
| Rate for Payer: Humana Commercial |
$341.92
|
| Rate for Payer: Humana KY Medicaid |
$138.34
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$139.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.99
|
| Rate for Payer: Ohio Health Group HMO |
$301.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.70
|
| Rate for Payer: PHCS Commercial |
$386.17
|
| Rate for Payer: United Healthcare All Payer |
$353.99
|
|
|
PAIR/CUT BEN HYPERKER LES 4+
|
Facility
|
IP
|
$402.26
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.29 |
| Max. Negotiated Rate |
$386.17 |
| Rate for Payer: Aetna Commercial |
$309.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.76
|
| Rate for Payer: Cash Price |
$201.13
|
| Rate for Payer: Cigna Commercial |
$333.88
|
| Rate for Payer: First Health Commercial |
$382.15
|
| Rate for Payer: Humana Commercial |
$341.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.99
|
| Rate for Payer: Ohio Health Group HMO |
$301.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.70
|
| Rate for Payer: PHCS Commercial |
$386.17
|
| Rate for Payer: United Healthcare All Payer |
$353.99
|
|
|
PAIR/CUT BEN HYPERKER LES 4+
|
Professional
|
Both
|
$402.26
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
76100033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$402.26 |
| Rate for Payer: Aetna Commercial |
$65.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.43
|
| Rate for Payer: Anthem Medicaid |
$22.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.26
|
| Rate for Payer: Cash Price |
$201.13
|
| Rate for Payer: Cash Price |
$201.13
|
| Rate for Payer: Cigna Commercial |
$92.25
|
| Rate for Payer: Healthspan PPO |
$80.68
|
| Rate for Payer: Humana Medicaid |
$22.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.56
|
| Rate for Payer: Molina Healthcare Passport |
$22.12
|
| Rate for Payer: Multiplan PHCS |
$241.36
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$281.58
|
| Rate for Payer: UHCCP Medicaid |
$22.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.34
|
|
|
PAIR/CUT BEN HYPERKER LES 4+(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
761P0033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$65.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.43
|
| Rate for Payer: Anthem Medicaid |
$22.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$92.25
|
| Rate for Payer: Healthspan PPO |
$80.68
|
| Rate for Payer: Humana Medicaid |
$22.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.56
|
| Rate for Payer: Molina Healthcare Passport |
$22.12
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$22.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.34
|
|
|
PAIR/CUT BEN HYPERKER LES 4+(T
|
Facility
|
IP
|
$252.26
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
761T0033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.79 |
| Max. Negotiated Rate |
$242.17 |
| Rate for Payer: Aetna Commercial |
$194.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.76
|
| Rate for Payer: Cash Price |
$126.13
|
| Rate for Payer: Cigna Commercial |
$209.38
|
| Rate for Payer: First Health Commercial |
$239.65
|
| Rate for Payer: Humana Commercial |
$214.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$186.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.99
|
| Rate for Payer: Ohio Health Group HMO |
$189.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.20
|
| Rate for Payer: PHCS Commercial |
$242.17
|
| Rate for Payer: United Healthcare All Payer |
$221.99
|
|
|
PAIR/CUT BEN HYPERKER LES 4+(T
|
Facility
|
OP
|
$252.26
|
|
|
Service Code
|
HCPCS 11057
|
| Hospital Charge Code |
761T0033
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.79 |
| Max. Negotiated Rate |
$242.37 |
| Rate for Payer: Aetna Commercial |
$194.24
|
| Rate for Payer: Anthem Medicaid |
$86.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$126.13
|
| Rate for Payer: Cash Price |
$126.13
|
| Rate for Payer: Cigna Commercial |
$209.38
|
| Rate for Payer: First Health Commercial |
$239.65
|
| Rate for Payer: Humana Commercial |
$214.42
|
| Rate for Payer: Humana KY Medicaid |
$86.75
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$87.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$186.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.99
|
| Rate for Payer: Ohio Health Group HMO |
$189.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.20
|
| Rate for Payer: PHCS Commercial |
$242.17
|
| Rate for Payer: United Healthcare All Payer |
$221.99
|
|
|
PALACOS LV 1*40 SINGLE
|
Facility
|
OP
|
$1,820.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.70 |
| Max. Negotiated Rate |
$1,747.92 |
| Rate for Payer: Aetna Commercial |
$1,401.98
|
| Rate for Payer: Anthem Medicaid |
$626.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,420.18
|
| Rate for Payer: Cash Price |
$910.38
|
| Rate for Payer: Cigna Commercial |
$1,511.22
|
| Rate for Payer: First Health Commercial |
$1,729.71
|
| Rate for Payer: Humana Commercial |
$1,547.64
|
| Rate for Payer: Humana KY Medicaid |
$626.16
|
| Rate for Payer: Kentucky WC Medicaid |
$632.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,493.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,602.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.43
|
| Rate for Payer: PHCS Commercial |
$1,747.92
|
| Rate for Payer: United Healthcare All Payer |
$1,602.26
|
|
|
PALACOS LV 1*40 SINGLE
|
Facility
|
IP
|
$1,820.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.70 |
| Max. Negotiated Rate |
$1,747.92 |
| Rate for Payer: Aetna Commercial |
$1,401.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,420.18
|
| Rate for Payer: Cash Price |
$910.38
|
| Rate for Payer: Cigna Commercial |
$1,511.22
|
| Rate for Payer: First Health Commercial |
$1,729.71
|
| Rate for Payer: Humana Commercial |
$1,547.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,493.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,602.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.43
|
| Rate for Payer: PHCS Commercial |
$1,747.92
|
| Rate for Payer: United Healthcare All Payer |
$1,602.26
|
|
|
PALACOS LVG 1*40 SINGLE
|
Facility
|
IP
|
$3,755.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.17 |
| Max. Negotiated Rate |
$3,604.92 |
| Rate for Payer: Aetna Commercial |
$2,891.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,928.99
|
| Rate for Payer: Cash Price |
$1,877.56
|
| Rate for Payer: Cigna Commercial |
$3,116.75
|
| Rate for Payer: First Health Commercial |
$3,567.36
|
| Rate for Payer: Humana Commercial |
$3,191.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,079.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,771.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,126.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,304.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,816.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$751.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.09
|
| Rate for Payer: PHCS Commercial |
$3,604.92
|
| Rate for Payer: United Healthcare All Payer |
$3,304.51
|
|
|
PALACOS LVG 1*40 SINGLE
|
Facility
|
OP
|
$3,755.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.17 |
| Max. Negotiated Rate |
$3,604.92 |
| Rate for Payer: Aetna Commercial |
$2,891.44
|
| Rate for Payer: Anthem Medicaid |
$1,291.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,928.99
|
| Rate for Payer: Cash Price |
$1,877.56
|
| Rate for Payer: Cigna Commercial |
$3,116.75
|
| Rate for Payer: First Health Commercial |
$3,567.36
|
| Rate for Payer: Humana Commercial |
$3,191.85
|
| Rate for Payer: Humana KY Medicaid |
$1,291.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,304.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,079.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,771.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,126.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,317.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,304.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,816.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$751.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.09
|
| Rate for Payer: PHCS Commercial |
$3,604.92
|
| Rate for Payer: United Healthcare All Payer |
$3,304.51
|
|
|
PALATOPHARYNGOPLASTY
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 42145
|
| Hospital Charge Code |
76101674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
PALATOPHARYNGOPLASTY
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 42145
|
| Hospital Charge Code |
76101674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
PALATOPHARYNGOPLASTY
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 42145
|
| Hospital Charge Code |
76101674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.48 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,006.32
|
| Rate for Payer: Anthem Medicaid |
$483.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$977.17
|
| Rate for Payer: Healthspan PPO |
$848.65
|
| Rate for Payer: Humana Medicaid |
$483.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$907.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.15
|
| Rate for Payer: Molina Healthcare Passport |
$483.48
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.31
|
|
|
PALATOPHARYNGOPLASTY(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 42145
|
| Hospital Charge Code |
761P1674
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.48 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,006.32
|
| Rate for Payer: Anthem Medicaid |
$483.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$977.17
|
| Rate for Payer: Healthspan PPO |
$848.65
|
| Rate for Payer: Humana Medicaid |
$483.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$907.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.15
|
| Rate for Payer: Molina Healthcare Passport |
$483.48
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.31
|
|
|
PALMAZ BLUE SLALOM 4*12*135
|
Facility
|
OP
|
$7,293.66
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.18 |
| Max. Negotiated Rate |
$7,001.91 |
| Rate for Payer: Aetna Commercial |
$5,616.12
|
| Rate for Payer: Anthem Medicaid |
$2,508.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,689.05
|
| Rate for Payer: Cash Price |
$3,646.83
|
| Rate for Payer: Cigna Commercial |
$6,053.74
|
| Rate for Payer: First Health Commercial |
$6,928.98
|
| Rate for Payer: Humana Commercial |
$6,199.61
|
| Rate for Payer: Humana KY Medicaid |
$2,508.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,533.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,980.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,382.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,188.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,558.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,418.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,470.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$948.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,261.03
|
| Rate for Payer: PHCS Commercial |
$7,001.91
|
| Rate for Payer: United Healthcare All Payer |
$6,418.42
|
|
|
PALMAZ BLUE SLALOM 4*12*135
|
Facility
|
IP
|
$7,293.66
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.18 |
| Max. Negotiated Rate |
$7,001.91 |
| Rate for Payer: Aetna Commercial |
$5,616.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,689.05
|
| Rate for Payer: Cash Price |
$3,646.83
|
| Rate for Payer: Cigna Commercial |
$6,053.74
|
| Rate for Payer: First Health Commercial |
$6,928.98
|
| Rate for Payer: Humana Commercial |
$6,199.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,980.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,382.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,188.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,418.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,470.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$948.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,261.03
|
| Rate for Payer: PHCS Commercial |
$7,001.91
|
| Rate for Payer: United Healthcare All Payer |
$6,418.42
|
|
|
PALMAZ BLUE SLALOM 4*12*80
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PALMAZ BLUE SLALOM 4*12*80
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
