|
PANCREATECTMY - DIISTL SUBT(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 48140
|
| Hospital Charge Code |
761P1971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$2,248.40
|
| Rate for Payer: Anthem Medicaid |
$961.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,086.00
|
| Rate for Payer: Healthspan PPO |
$1,896.12
|
| Rate for Payer: Humana Medicaid |
$961.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,994.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$980.57
|
| Rate for Payer: Molina Healthcare Passport |
$961.34
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$970.95
|
|
|
PANOPTIX LENS TFNT00+24.0
|
Facility
|
OP
|
$5,682.50
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem Medicaid |
$1,954.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Humana KY Medicaid |
$1,954.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,993.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
PANOPTIX LENS TFNT00+24.0
|
Facility
|
IP
|
$5,682.50
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
PANOPTIX LENS TFNT30 +16.0
|
Facility
|
IP
|
$5,682.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
PANOPTIX LENS TFNT30 +16.0
|
Facility
|
OP
|
$5,682.50
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem Medicaid |
$1,954.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Humana KY Medicaid |
$1,954.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,993.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
PANOPTIX LENS TFNT30(T)
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
PANOPTIX LENS TFNT30(T)
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
PANTHERIS 7F
|
Facility
|
OP
|
$14,231.75
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,850.13 |
| Max. Negotiated Rate |
$13,662.48 |
| Rate for Payer: Aetna Commercial |
$10,958.45
|
| Rate for Payer: Anthem Medicaid |
$4,894.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,100.76
|
| Rate for Payer: Cash Price |
$7,115.88
|
| Rate for Payer: Cigna Commercial |
$11,812.35
|
| Rate for Payer: First Health Commercial |
$13,520.16
|
| Rate for Payer: Humana Commercial |
$12,096.99
|
| Rate for Payer: Humana KY Medicaid |
$4,894.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,944.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,670.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,503.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,269.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,992.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,523.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,673.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,411.84
|
| Rate for Payer: PHCS Commercial |
$13,662.48
|
| Rate for Payer: United Healthcare All Payer |
$12,523.94
|
|
|
PANTHERIS 7F
|
Facility
|
IP
|
$14,231.75
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,850.13 |
| Max. Negotiated Rate |
$13,662.48 |
| Rate for Payer: Aetna Commercial |
$10,958.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,100.76
|
| Rate for Payer: Cash Price |
$7,115.88
|
| Rate for Payer: Cigna Commercial |
$11,812.35
|
| Rate for Payer: First Health Commercial |
$13,520.16
|
| Rate for Payer: Humana Commercial |
$12,096.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,670.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,503.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,269.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,523.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,673.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,411.84
|
| Rate for Payer: PHCS Commercial |
$13,662.48
|
| Rate for Payer: United Healthcare All Payer |
$12,523.94
|
|
|
PANTHERIS 7F LONG NOSE CONE
|
Facility
|
OP
|
$14,231.75
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,850.13 |
| Max. Negotiated Rate |
$13,662.48 |
| Rate for Payer: Aetna Commercial |
$10,958.45
|
| Rate for Payer: Anthem Medicaid |
$4,894.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,100.76
|
| Rate for Payer: Cash Price |
$7,115.88
|
| Rate for Payer: Cigna Commercial |
$11,812.35
|
| Rate for Payer: First Health Commercial |
$13,520.16
|
| Rate for Payer: Humana Commercial |
$12,096.99
|
| Rate for Payer: Humana KY Medicaid |
$4,894.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,944.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,670.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,503.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,269.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,992.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,523.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,673.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,411.84
|
| Rate for Payer: PHCS Commercial |
$13,662.48
|
| Rate for Payer: United Healthcare All Payer |
$12,523.94
|
|
|
PANTHERIS 7F LONG NOSE CONE
|
Facility
|
IP
|
$14,231.75
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,850.13 |
| Max. Negotiated Rate |
$13,662.48 |
| Rate for Payer: Aetna Commercial |
$10,958.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,100.76
|
| Rate for Payer: Cash Price |
$7,115.88
|
| Rate for Payer: Cigna Commercial |
$11,812.35
|
| Rate for Payer: First Health Commercial |
$13,520.16
|
| Rate for Payer: Humana Commercial |
$12,096.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,670.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,503.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,269.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,523.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,673.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,411.84
|
| Rate for Payer: PHCS Commercial |
$13,662.48
|
| Rate for Payer: United Healthcare All Payer |
$12,523.94
|
|
|
PANTHERIS 8F
|
Facility
|
IP
|
$14,231.75
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,850.13 |
| Max. Negotiated Rate |
$13,662.48 |
| Rate for Payer: Aetna Commercial |
$10,958.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,100.76
|
| Rate for Payer: Cash Price |
$7,115.88
|
| Rate for Payer: Cigna Commercial |
$11,812.35
|
| Rate for Payer: First Health Commercial |
$13,520.16
|
| Rate for Payer: Humana Commercial |
$12,096.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,670.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,503.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,269.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,523.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,673.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,411.84
|
| Rate for Payer: PHCS Commercial |
$13,662.48
|
| Rate for Payer: United Healthcare All Payer |
$12,523.94
|
|
|
PANTHERIS 8F
|
Facility
|
OP
|
$14,231.75
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,850.13 |
| Max. Negotiated Rate |
$13,662.48 |
| Rate for Payer: Aetna Commercial |
$10,958.45
|
| Rate for Payer: Anthem Medicaid |
$4,894.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,100.76
|
| Rate for Payer: Cash Price |
$7,115.88
|
| Rate for Payer: Cigna Commercial |
$11,812.35
|
| Rate for Payer: First Health Commercial |
$13,520.16
|
| Rate for Payer: Humana Commercial |
$12,096.99
|
| Rate for Payer: Humana KY Medicaid |
$4,894.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,944.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,670.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,503.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,269.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,992.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,523.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,673.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,411.84
|
| Rate for Payer: PHCS Commercial |
$13,662.48
|
| Rate for Payer: United Healthcare All Payer |
$12,523.94
|
|
|
PANTHERIS SLED
|
Facility
|
OP
|
$26,681.75
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,468.63 |
| Max. Negotiated Rate |
$25,614.48 |
| Rate for Payer: Aetna Commercial |
$20,544.95
|
| Rate for Payer: Anthem Medicaid |
$9,175.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,811.76
|
| Rate for Payer: Cash Price |
$13,340.88
|
| Rate for Payer: Cigna Commercial |
$22,145.85
|
| Rate for Payer: First Health Commercial |
$25,347.66
|
| Rate for Payer: Humana Commercial |
$22,679.49
|
| Rate for Payer: Humana KY Medicaid |
$9,175.85
|
| Rate for Payer: Kentucky WC Medicaid |
$9,269.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,879.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,691.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,004.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,359.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,479.94
|
| Rate for Payer: Ohio Health Group HMO |
$20,011.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,468.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,271.34
|
| Rate for Payer: PHCS Commercial |
$25,614.48
|
| Rate for Payer: United Healthcare All Payer |
$23,479.94
|
|
|
PANTHERIS SLED
|
Facility
|
IP
|
$26,681.75
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,468.63 |
| Max. Negotiated Rate |
$25,614.48 |
| Rate for Payer: Aetna Commercial |
$20,544.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,811.76
|
| Rate for Payer: Cash Price |
$13,340.88
|
| Rate for Payer: Cigna Commercial |
$22,145.85
|
| Rate for Payer: First Health Commercial |
$25,347.66
|
| Rate for Payer: Humana Commercial |
$22,679.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,879.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,691.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,004.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,479.94
|
| Rate for Payer: Ohio Health Group HMO |
$20,011.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,468.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,271.34
|
| Rate for Payer: PHCS Commercial |
$25,614.48
|
| Rate for Payer: United Healthcare All Payer |
$23,479.94
|
|
|
PANTHERIS SV 6F
|
Facility
|
OP
|
$14,231.75
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,850.13 |
| Max. Negotiated Rate |
$13,662.48 |
| Rate for Payer: Aetna Commercial |
$10,958.45
|
| Rate for Payer: Anthem Medicaid |
$4,894.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,100.76
|
| Rate for Payer: Cash Price |
$7,115.88
|
| Rate for Payer: Cigna Commercial |
$11,812.35
|
| Rate for Payer: First Health Commercial |
$13,520.16
|
| Rate for Payer: Humana Commercial |
$12,096.99
|
| Rate for Payer: Humana KY Medicaid |
$4,894.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,944.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,670.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,503.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,269.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,992.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,523.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,673.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,411.84
|
| Rate for Payer: PHCS Commercial |
$13,662.48
|
| Rate for Payer: United Healthcare All Payer |
$12,523.94
|
|
|
PANTHERIS SV 6F
|
Facility
|
IP
|
$14,231.75
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,850.13 |
| Max. Negotiated Rate |
$13,662.48 |
| Rate for Payer: Aetna Commercial |
$10,958.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,100.76
|
| Rate for Payer: Cash Price |
$7,115.88
|
| Rate for Payer: Cigna Commercial |
$11,812.35
|
| Rate for Payer: First Health Commercial |
$13,520.16
|
| Rate for Payer: Humana Commercial |
$12,096.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,670.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,503.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,269.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,523.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,673.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,850.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,411.84
|
| Rate for Payer: PHCS Commercial |
$13,662.48
|
| Rate for Payer: United Healthcare All Payer |
$12,523.94
|
|
|
PAPAVERINE 60MG/2ML VIAL
|
Facility
|
IP
|
$204.38
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
25002301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna Commercial |
$157.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.42
|
| Rate for Payer: Cash Price |
$102.19
|
| Rate for Payer: Cigna Commercial |
$169.64
|
| Rate for Payer: First Health Commercial |
$194.16
|
| Rate for Payer: Humana Commercial |
$173.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.85
|
| Rate for Payer: Ohio Health Group HMO |
$153.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.36
|
| Rate for Payer: PHCS Commercial |
$196.20
|
| Rate for Payer: United Healthcare All Payer |
$179.85
|
|
|
PAPAVERINE 60MG/2ML VIAL
|
Facility
|
OP
|
$204.38
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
25002301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna Commercial |
$157.37
|
| Rate for Payer: Anthem Medicaid |
$70.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.42
|
| Rate for Payer: Cash Price |
$102.19
|
| Rate for Payer: Cigna Commercial |
$169.64
|
| Rate for Payer: First Health Commercial |
$194.16
|
| Rate for Payer: Humana Commercial |
$173.72
|
| Rate for Payer: Humana KY Medicaid |
$70.29
|
| Rate for Payer: Kentucky WC Medicaid |
$71.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.85
|
| Rate for Payer: Ohio Health Group HMO |
$153.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.36
|
| Rate for Payer: PHCS Commercial |
$196.20
|
| Rate for Payer: United Healthcare All Payer |
$179.85
|
|
|
PAPER PATCH MYRINGOPLASTY
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 69610
|
| Hospital Charge Code |
76102428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
PAPER PATCH MYRINGOPLASTY
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 69610
|
| Hospital Charge Code |
76102428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.43 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$433.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$146.91
|
| Rate for Payer: Anthem Medicaid |
$143.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$434.65
|
| Rate for Payer: Healthspan PPO |
$492.23
|
| Rate for Payer: Humana Medicaid |
$143.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$379.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.30
|
| Rate for Payer: Molina Healthcare Passport |
$143.43
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$154.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.86
|
|
|
PAPER PATCH MYRINGOPLASTY
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 69610
|
| Hospital Charge Code |
76102428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.14
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
PAPER PATCH MYRINGOPLASTY(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 69610
|
| Hospital Charge Code |
761P2428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.43 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$433.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$146.91
|
| Rate for Payer: Anthem Medicaid |
$143.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$434.65
|
| Rate for Payer: Healthspan PPO |
$492.23
|
| Rate for Payer: Humana Medicaid |
$143.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$379.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.30
|
| Rate for Payer: Molina Healthcare Passport |
$143.43
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$154.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.86
|
|
|
PARACENTESIS WITH IMAGING
|
Facility
|
IP
|
$2,714.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
76102767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.82 |
| Max. Negotiated Rate |
$2,605.44 |
| Rate for Payer: Aetna Commercial |
$2,089.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,116.92
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cigna Commercial |
$2,252.62
|
| Rate for Payer: First Health Commercial |
$2,578.30
|
| Rate for Payer: Humana Commercial |
$2,306.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,225.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,002.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$814.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,388.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,035.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$542.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.34
|
| Rate for Payer: PHCS Commercial |
$2,605.44
|
| Rate for Payer: United Healthcare All Payer |
$2,388.32
|
|
|
PARACENTESIS WITH IMAGING
|
Professional
|
Both
|
$2,714.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
76102767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.96 |
| Max. Negotiated Rate |
$2,714.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.65
|
| Rate for Payer: Anthem Medicaid |
$86.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,714.00
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cash Price |
$1,357.00
|
| Rate for Payer: Cigna Commercial |
$182.46
|
| Rate for Payer: Healthspan PPO |
$287.25
|
| Rate for Payer: Humana Medicaid |
$86.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.70
|
| Rate for Payer: Molina Healthcare Passport |
$86.96
|
| Rate for Payer: Multiplan PHCS |
$1,628.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,899.80
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.83
|
|
