|
PERC NEPH NEW ACC W NEPH CATH
|
Facility
|
IP
|
$5,862.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
76102056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$762.06 |
| Max. Negotiated Rate |
$5,627.52 |
| Rate for Payer: Aetna Commercial |
$4,513.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,572.36
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$4,865.46
|
| Rate for Payer: First Health Commercial |
$5,568.90
|
| Rate for Payer: Humana Commercial |
$4,982.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,806.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,326.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,758.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$762.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,817.22
|
| Rate for Payer: PHCS Commercial |
$5,627.52
|
| Rate for Payer: United Healthcare All Payer |
$5,158.56
|
|
|
PERC NEPH NEW ACC W NEPH CATH
|
Professional
|
Both
|
$5,862.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
76102056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.23 |
| Max. Negotiated Rate |
$5,862.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$290.23
|
| Rate for Payer: Anthem Medicaid |
$293.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,862.00
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$599.18
|
| Rate for Payer: Humana Medicaid |
$293.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$489.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.00
|
| Rate for Payer: Molina Healthcare Passport |
$293.14
|
| Rate for Payer: Multiplan PHCS |
$3,517.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,103.40
|
| Rate for Payer: UHCCP Medicaid |
$304.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.07
|
|
|
PERC NEPH NEW ACC W NEPH CATH
|
Facility
|
OP
|
$5,862.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
76102056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$762.06 |
| Max. Negotiated Rate |
$5,627.52 |
| Rate for Payer: Aetna Commercial |
$4,513.74
|
| Rate for Payer: Anthem Medicaid |
$2,015.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,572.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$4,865.46
|
| Rate for Payer: First Health Commercial |
$5,568.90
|
| Rate for Payer: Humana Commercial |
$4,982.70
|
| Rate for Payer: Humana KY Medicaid |
$2,015.94
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,036.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,806.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,326.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,056.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$762.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,817.22
|
| Rate for Payer: PHCS Commercial |
$5,627.52
|
| Rate for Payer: United Healthcare All Payer |
$5,158.56
|
|
|
PERC NEPH NEW ACC W/O CATH (P
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 50694
|
| Hospital Charge Code |
761P2055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.95 |
| Max. Negotiated Rate |
$1,130.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$228.95
|
| Rate for Payer: Anthem Medicaid |
$231.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,130.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$471.97
|
| Rate for Payer: Humana Medicaid |
$231.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$385.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$235.76
|
| Rate for Payer: Molina Healthcare Passport |
$231.14
|
| Rate for Payer: Multiplan PHCS |
$678.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$791.00
|
| Rate for Payer: UHCCP Medicaid |
$240.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$233.45
|
|
|
PERC NEPH NEW ACC W/O CATH (T
|
Facility
|
IP
|
$4,507.00
|
|
|
Service Code
|
HCPCS 50694
|
| Hospital Charge Code |
761T2055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.91 |
| Max. Negotiated Rate |
$4,326.72 |
| Rate for Payer: Aetna Commercial |
$3,470.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,515.46
|
| Rate for Payer: Cash Price |
$2,253.50
|
| Rate for Payer: Cigna Commercial |
$3,740.81
|
| Rate for Payer: First Health Commercial |
$4,281.65
|
| Rate for Payer: Humana Commercial |
$3,830.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,695.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,326.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,352.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,966.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$901.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,397.17
|
| Rate for Payer: PHCS Commercial |
$4,326.72
|
| Rate for Payer: United Healthcare All Payer |
$3,966.16
|
|
|
PERC NEPH NEW ACC W/O CATH (T
|
Facility
|
OP
|
$4,507.00
|
|
|
Service Code
|
HCPCS 50694
|
| Hospital Charge Code |
761T2055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.91 |
| Max. Negotiated Rate |
$4,326.72 |
| Rate for Payer: Aetna Commercial |
$3,470.39
|
| Rate for Payer: Anthem Medicaid |
$1,549.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,515.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$2,253.50
|
| Rate for Payer: Cash Price |
$2,253.50
|
| Rate for Payer: Cigna Commercial |
$3,740.81
|
| Rate for Payer: First Health Commercial |
$4,281.65
|
| Rate for Payer: Humana Commercial |
$3,830.95
|
| Rate for Payer: Humana KY Medicaid |
$1,549.96
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,565.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,695.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,326.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,581.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,966.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$901.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,397.17
|
| Rate for Payer: PHCS Commercial |
$4,326.72
|
| Rate for Payer: United Healthcare All Payer |
$3,966.16
|
|
|
PERC NEPH PLACEMENT
|
Facility
|
OP
|
$3,147.00
|
|
|
Service Code
|
HCPCS 50432
|
| Hospital Charge Code |
76102048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.11 |
| Max. Negotiated Rate |
$3,021.12 |
| Rate for Payer: Aetna Commercial |
$2,423.19
|
| Rate for Payer: Anthem Medicaid |
$1,082.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,454.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,573.50
|
| Rate for Payer: Cash Price |
$1,573.50
|
| Rate for Payer: Cigna Commercial |
$2,612.01
|
| Rate for Payer: First Health Commercial |
$2,989.65
|
| Rate for Payer: Humana Commercial |
$2,674.95
|
| Rate for Payer: Humana KY Medicaid |
$1,082.25
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,103.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$629.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$975.57
|
| Rate for Payer: PHCS Commercial |
$3,021.12
|
| Rate for Payer: United Healthcare All Payer |
$2,769.36
|
|
|
PERC NEPH PLACEMENT
|
Professional
|
Both
|
$3,147.00
|
|
|
Service Code
|
HCPCS 50432
|
| Hospital Charge Code |
76102048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$3,147.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$178.65
|
| Rate for Payer: Anthem Medicaid |
$180.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,147.00
|
| Rate for Payer: Cash Price |
$1,573.50
|
| Rate for Payer: Cash Price |
$1,573.50
|
| Rate for Payer: Cigna Commercial |
$369.04
|
| Rate for Payer: Humana Medicaid |
$180.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$301.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$183.97
|
| Rate for Payer: Molina Healthcare Passport |
$180.36
|
| Rate for Payer: Multiplan PHCS |
$1,888.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,202.90
|
| Rate for Payer: UHCCP Medicaid |
$187.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.16
|
|
|
PERC NEPH PLACEMENT
|
Facility
|
IP
|
$3,147.00
|
|
|
Service Code
|
HCPCS 50432
|
| Hospital Charge Code |
76102048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.11 |
| Max. Negotiated Rate |
$3,021.12 |
| Rate for Payer: Aetna Commercial |
$2,423.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,454.66
|
| Rate for Payer: Cash Price |
$1,573.50
|
| Rate for Payer: Cigna Commercial |
$2,612.01
|
| Rate for Payer: First Health Commercial |
$2,989.65
|
| Rate for Payer: Humana Commercial |
$2,674.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$629.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$975.57
|
| Rate for Payer: PHCS Commercial |
$3,021.12
|
| Rate for Payer: United Healthcare All Payer |
$2,769.36
|
|
|
PERC NEPH PLACEMENT(P
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 50432
|
| Hospital Charge Code |
761P2048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$178.65
|
| Rate for Payer: Anthem Medicaid |
$180.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$369.04
|
| Rate for Payer: Humana Medicaid |
$180.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$301.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$183.97
|
| Rate for Payer: Molina Healthcare Passport |
$180.36
|
| Rate for Payer: Multiplan PHCS |
$366.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$427.00
|
| Rate for Payer: UHCCP Medicaid |
$187.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.16
|
|
|
PERC NEPH PLACEMENT(T
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 50432
|
| Hospital Charge Code |
761T2048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.81 |
| Max. Negotiated Rate |
$2,435.52 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$761.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.47
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
PERC NEPH PLACEMENT(T
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 50432
|
| Hospital Charge Code |
761T2048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.81 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem Medicaid |
$872.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Humana KY Medicaid |
$872.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$881.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$889.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.47
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
PERCOCET 10/325MG TABLET
|
Facility
|
IP
|
$61.72
|
|
|
Service Code
|
NDC 68084071001
|
| Hospital Charge Code |
25003349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Aetna Commercial |
$47.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.14
|
| Rate for Payer: Cash Price |
$30.86
|
| Rate for Payer: Cigna Commercial |
$51.23
|
| Rate for Payer: First Health Commercial |
$58.63
|
| Rate for Payer: Humana Commercial |
$52.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.31
|
| Rate for Payer: Ohio Health Group HMO |
$46.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.13
|
| Rate for Payer: PHCS Commercial |
$59.25
|
| Rate for Payer: United Healthcare All Payer |
$54.31
|
|
|
PERCOCET 10/325MG TABLET
|
Facility
|
OP
|
$61.72
|
|
|
Service Code
|
NDC 68084071001
|
| Hospital Charge Code |
25003349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Aetna Commercial |
$47.52
|
| Rate for Payer: Anthem Medicaid |
$21.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.14
|
| Rate for Payer: Cash Price |
$30.86
|
| Rate for Payer: Cigna Commercial |
$51.23
|
| Rate for Payer: First Health Commercial |
$58.63
|
| Rate for Payer: Humana Commercial |
$52.46
|
| Rate for Payer: Humana KY Medicaid |
$21.23
|
| Rate for Payer: Kentucky WC Medicaid |
$21.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.31
|
| Rate for Payer: Ohio Health Group HMO |
$46.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.13
|
| Rate for Payer: PHCS Commercial |
$59.25
|
| Rate for Payer: United Healthcare All Payer |
$54.31
|
|
|
PERCOCET 7.5/325MG TABLET
|
Facility
|
IP
|
$60.15
|
|
|
Service Code
|
NDC 13107004501
|
| Hospital Charge Code |
25001174
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.92
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cigna Commercial |
$49.92
|
| Rate for Payer: First Health Commercial |
$57.14
|
| Rate for Payer: Humana Commercial |
$51.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.93
|
| Rate for Payer: Ohio Health Group HMO |
$45.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.65
|
| Rate for Payer: PHCS Commercial |
$57.74
|
| Rate for Payer: United Healthcare All Payer |
$52.93
|
|
|
PERCOCET 7.5/325MG TABLET
|
Facility
|
OP
|
$60.15
|
|
|
Service Code
|
NDC 13107004501
|
| Hospital Charge Code |
25001174
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Anthem Medicaid |
$20.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.92
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cigna Commercial |
$49.92
|
| Rate for Payer: First Health Commercial |
$57.14
|
| Rate for Payer: Humana Commercial |
$51.13
|
| Rate for Payer: Humana KY Medicaid |
$20.69
|
| Rate for Payer: Kentucky WC Medicaid |
$20.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.93
|
| Rate for Payer: Ohio Health Group HMO |
$45.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.65
|
| Rate for Payer: PHCS Commercial |
$57.74
|
| Rate for Payer: United Healthcare All Payer |
$52.93
|
|
|
PERC PORTAL VEINCATH ANYMETHOD
|
Professional
|
Both
|
$3,241.14
|
|
|
Service Code
|
HCPCS 36481
|
| Hospital Charge Code |
76101467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$3,241.14 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.76
|
| Rate for Payer: Anthem Medicaid |
$362.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,241.14
|
| Rate for Payer: Cash Price |
$1,620.57
|
| Rate for Payer: Cash Price |
$1,620.57
|
| Rate for Payer: Cigna Commercial |
$537.59
|
| Rate for Payer: Healthspan PPO |
$517.41
|
| Rate for Payer: Humana Medicaid |
$362.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$464.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.33
|
| Rate for Payer: Molina Healthcare Passport |
$362.09
|
| Rate for Payer: Multiplan PHCS |
$1,944.68
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,268.80
|
| Rate for Payer: UHCCP Medicaid |
$266.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$365.71
|
|
|
PERC PORTAL VEINCATH ANYMETHOD
|
Facility
|
OP
|
$3,241.14
|
|
|
Service Code
|
HCPCS 36481
|
| Hospital Charge Code |
76101467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.35 |
| Max. Negotiated Rate |
$3,111.49 |
| Rate for Payer: Aetna Commercial |
$2,495.68
|
| Rate for Payer: Anthem Medicaid |
$1,114.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,528.09
|
| Rate for Payer: Cash Price |
$1,620.57
|
| Rate for Payer: Cigna Commercial |
$2,690.15
|
| Rate for Payer: First Health Commercial |
$3,079.08
|
| Rate for Payer: Humana Commercial |
$2,754.97
|
| Rate for Payer: Humana KY Medicaid |
$1,114.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,125.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,657.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,391.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$972.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,136.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,852.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,430.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,004.75
|
| Rate for Payer: PHCS Commercial |
$3,111.49
|
| Rate for Payer: United Healthcare All Payer |
$2,852.20
|
|
|
PERC PORTAL VEINCATH ANYMETHOD
|
Facility
|
IP
|
$3,241.14
|
|
|
Service Code
|
HCPCS 36481
|
| Hospital Charge Code |
76101467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.35 |
| Max. Negotiated Rate |
$3,111.49 |
| Rate for Payer: Aetna Commercial |
$2,495.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,528.09
|
| Rate for Payer: Cash Price |
$1,620.57
|
| Rate for Payer: Cigna Commercial |
$2,690.15
|
| Rate for Payer: First Health Commercial |
$3,079.08
|
| Rate for Payer: Humana Commercial |
$2,754.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,657.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,391.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$972.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,852.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,430.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,004.75
|
| Rate for Payer: PHCS Commercial |
$3,111.49
|
| Rate for Payer: United Healthcare All Payer |
$2,852.20
|
|
|
PERC PORTAL VEINCATH ANYMETHOD
|
Facility
|
OP
|
$2,701.14
|
|
|
Service Code
|
HCPCS 36481
|
| Hospital Charge Code |
761T1467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.15 |
| Max. Negotiated Rate |
$2,593.09 |
| Rate for Payer: Aetna Commercial |
$2,079.88
|
| Rate for Payer: Anthem Medicaid |
$928.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.89
|
| Rate for Payer: Cash Price |
$1,350.57
|
| Rate for Payer: Cigna Commercial |
$2,241.95
|
| Rate for Payer: First Health Commercial |
$2,566.08
|
| Rate for Payer: Humana Commercial |
$2,295.97
|
| Rate for Payer: Humana KY Medicaid |
$928.92
|
| Rate for Payer: Kentucky WC Medicaid |
$938.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,993.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.35
|
| Rate for Payer: PHCS Commercial |
$2,593.09
|
| Rate for Payer: United Healthcare All Payer |
$2,377.00
|
|
|
PERC PORTAL VEINCATH ANYMETHOD
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 36481
|
| Hospital Charge Code |
761P1467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$647.10 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.76
|
| Rate for Payer: Anthem Medicaid |
$362.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$540.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$537.59
|
| Rate for Payer: Healthspan PPO |
$517.41
|
| Rate for Payer: Humana Medicaid |
$362.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$464.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.33
|
| Rate for Payer: Molina Healthcare Passport |
$362.09
|
| Rate for Payer: Multiplan PHCS |
$324.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$378.00
|
| Rate for Payer: UHCCP Medicaid |
$266.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$365.71
|
|
|
PERC PORTAL VEINCATH ANYMETHOD
|
Facility
|
IP
|
$2,701.14
|
|
|
Service Code
|
HCPCS 36481
|
| Hospital Charge Code |
761T1467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.15 |
| Max. Negotiated Rate |
$2,593.09 |
| Rate for Payer: Aetna Commercial |
$2,079.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.89
|
| Rate for Payer: Cash Price |
$1,350.57
|
| Rate for Payer: Cigna Commercial |
$2,241.95
|
| Rate for Payer: First Health Commercial |
$2,566.08
|
| Rate for Payer: Humana Commercial |
$2,295.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,993.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.35
|
| Rate for Payer: PHCS Commercial |
$2,593.09
|
| Rate for Payer: United Healthcare All Payer |
$2,377.00
|
|
|
PERC SKEL FIX HUM EPCNDYLR F(P
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 24566
|
| Hospital Charge Code |
761P0543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.26 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: Aetna Commercial |
$1,008.63
|
| Rate for Payer: Anthem Medicaid |
$396.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,825.00
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,105.79
|
| Rate for Payer: Healthspan PPO |
$913.60
|
| Rate for Payer: Humana Medicaid |
$396.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$877.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$404.19
|
| Rate for Payer: Molina Healthcare Passport |
$396.26
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,277.50
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$400.22
|
|
|
PERC SKEL FIX HUM EPCNDYLR FX
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 24566
|
| Hospital Charge Code |
76100543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.26 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: Aetna Commercial |
$1,008.63
|
| Rate for Payer: Anthem Medicaid |
$396.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,825.00
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,105.79
|
| Rate for Payer: Healthspan PPO |
$913.60
|
| Rate for Payer: Humana Medicaid |
$396.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$877.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$404.19
|
| Rate for Payer: Molina Healthcare Passport |
$396.26
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,277.50
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$400.22
|
|
|
PERC SKEL FIX HUM EPCNDYLR FX
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 24566
|
| Hospital Charge Code |
76100543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.75
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
