|
PIGTAIL 110CM
|
Facility
|
OP
|
$504.10
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.53 |
| Max. Negotiated Rate |
$483.94 |
| Rate for Payer: Aetna Commercial |
$388.16
|
| Rate for Payer: Anthem Medicaid |
$173.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.20
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cigna Commercial |
$418.40
|
| Rate for Payer: First Health Commercial |
$478.90
|
| Rate for Payer: Humana Commercial |
$428.48
|
| Rate for Payer: Humana KY Medicaid |
$173.36
|
| Rate for Payer: Kentucky WC Medicaid |
$175.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$372.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$176.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.61
|
| Rate for Payer: Ohio Health Group HMO |
$378.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.27
|
| Rate for Payer: PHCS Commercial |
$483.94
|
| Rate for Payer: United Healthcare All Payer |
$443.61
|
|
|
PIGTAIL 145 CATH 5F
|
Facility
|
OP
|
$164.07
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.33 |
| Max. Negotiated Rate |
$157.51 |
| Rate for Payer: Aetna Commercial |
$126.33
|
| Rate for Payer: Anthem Medicaid |
$56.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.97
|
| Rate for Payer: Cash Price |
$82.03
|
| Rate for Payer: Cigna Commercial |
$136.18
|
| Rate for Payer: First Health Commercial |
$155.87
|
| Rate for Payer: Humana Commercial |
$139.46
|
| Rate for Payer: Humana KY Medicaid |
$56.42
|
| Rate for Payer: Kentucky WC Medicaid |
$57.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.38
|
| Rate for Payer: Ohio Health Group HMO |
$123.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.86
|
| Rate for Payer: PHCS Commercial |
$157.51
|
| Rate for Payer: United Healthcare All Payer |
$144.38
|
|
|
PIGTAIL 145 CATH 5F
|
Facility
|
IP
|
$164.07
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.33 |
| Max. Negotiated Rate |
$157.51 |
| Rate for Payer: Aetna Commercial |
$126.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.97
|
| Rate for Payer: Cash Price |
$82.03
|
| Rate for Payer: Cigna Commercial |
$136.18
|
| Rate for Payer: First Health Commercial |
$155.87
|
| Rate for Payer: Humana Commercial |
$139.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.38
|
| Rate for Payer: Ohio Health Group HMO |
$123.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.86
|
| Rate for Payer: PHCS Commercial |
$157.51
|
| Rate for Payer: United Healthcare All Payer |
$144.38
|
|
|
PIGTAIL 5FR 65CM
|
Facility
|
IP
|
$493.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$473.95 |
| Rate for Payer: Aetna Commercial |
$380.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.09
|
| Rate for Payer: Cash Price |
$246.85
|
| Rate for Payer: Cigna Commercial |
$409.77
|
| Rate for Payer: First Health Commercial |
$469.02
|
| Rate for Payer: Humana Commercial |
$419.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.46
|
| Rate for Payer: Ohio Health Group HMO |
$370.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.05
|
| Rate for Payer: PHCS Commercial |
$473.95
|
| Rate for Payer: United Healthcare All Payer |
$434.46
|
|
|
PIGTAIL 5FR 65CM
|
Facility
|
OP
|
$493.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$473.95 |
| Rate for Payer: Aetna Commercial |
$380.15
|
| Rate for Payer: Anthem Medicaid |
$169.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.09
|
| Rate for Payer: Cash Price |
$246.85
|
| Rate for Payer: Cigna Commercial |
$409.77
|
| Rate for Payer: First Health Commercial |
$469.02
|
| Rate for Payer: Humana Commercial |
$419.64
|
| Rate for Payer: Humana KY Medicaid |
$169.78
|
| Rate for Payer: Kentucky WC Medicaid |
$171.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.46
|
| Rate for Payer: Ohio Health Group HMO |
$370.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.05
|
| Rate for Payer: PHCS Commercial |
$473.95
|
| Rate for Payer: United Healthcare All Payer |
$434.46
|
|
|
PIGTAIL 5FR 90CM
|
Facility
|
IP
|
$493.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$473.95 |
| Rate for Payer: Aetna Commercial |
$380.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.09
|
| Rate for Payer: Cash Price |
$246.85
|
| Rate for Payer: Cigna Commercial |
$409.77
|
| Rate for Payer: First Health Commercial |
$469.02
|
| Rate for Payer: Humana Commercial |
$419.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.46
|
| Rate for Payer: Ohio Health Group HMO |
$370.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.05
|
| Rate for Payer: PHCS Commercial |
$473.95
|
| Rate for Payer: United Healthcare All Payer |
$434.46
|
|
|
PIGTAIL 5FR 90CM
|
Facility
|
OP
|
$493.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$473.95 |
| Rate for Payer: Aetna Commercial |
$380.15
|
| Rate for Payer: Anthem Medicaid |
$169.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.09
|
| Rate for Payer: Cash Price |
$246.85
|
| Rate for Payer: Cigna Commercial |
$409.77
|
| Rate for Payer: First Health Commercial |
$469.02
|
| Rate for Payer: Humana Commercial |
$419.64
|
| Rate for Payer: Humana KY Medicaid |
$169.78
|
| Rate for Payer: Kentucky WC Medicaid |
$171.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.46
|
| Rate for Payer: Ohio Health Group HMO |
$370.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.05
|
| Rate for Payer: PHCS Commercial |
$473.95
|
| Rate for Payer: United Healthcare All Payer |
$434.46
|
|
|
PIGTAIL 6F 110CM
|
Facility
|
OP
|
$164.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem Medicaid |
$56.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Humana KY Medicaid |
$56.64
|
| Rate for Payer: Kentucky WC Medicaid |
$57.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
PIGTAIL 6F 110CM
|
Facility
|
IP
|
$164.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
PIGTAIL ST. 4FR 90CM
|
Facility
|
OP
|
$493.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$473.95 |
| Rate for Payer: Aetna Commercial |
$380.15
|
| Rate for Payer: Anthem Medicaid |
$169.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.09
|
| Rate for Payer: Cash Price |
$246.85
|
| Rate for Payer: Cigna Commercial |
$409.77
|
| Rate for Payer: First Health Commercial |
$469.02
|
| Rate for Payer: Humana Commercial |
$419.64
|
| Rate for Payer: Humana KY Medicaid |
$169.78
|
| Rate for Payer: Kentucky WC Medicaid |
$171.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.46
|
| Rate for Payer: Ohio Health Group HMO |
$370.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.05
|
| Rate for Payer: PHCS Commercial |
$473.95
|
| Rate for Payer: United Healthcare All Payer |
$434.46
|
|
|
PIGTAIL ST. 4FR 90CM
|
Facility
|
IP
|
$493.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$473.95 |
| Rate for Payer: Aetna Commercial |
$380.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.09
|
| Rate for Payer: Cash Price |
$246.85
|
| Rate for Payer: Cigna Commercial |
$409.77
|
| Rate for Payer: First Health Commercial |
$469.02
|
| Rate for Payer: Humana Commercial |
$419.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.46
|
| Rate for Payer: Ohio Health Group HMO |
$370.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.05
|
| Rate for Payer: PHCS Commercial |
$473.95
|
| Rate for Payer: United Healthcare All Payer |
$434.46
|
|
|
PIGTAIL STR. 5F 110CM
|
Facility
|
IP
|
$514.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$493.92 |
| Rate for Payer: Aetna Commercial |
$396.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.31
|
| Rate for Payer: Cash Price |
$257.25
|
| Rate for Payer: Cigna Commercial |
$427.04
|
| Rate for Payer: First Health Commercial |
$488.78
|
| Rate for Payer: Humana Commercial |
$437.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$379.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$452.76
|
| Rate for Payer: Ohio Health Group HMO |
$385.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.50
|
| Rate for Payer: PHCS Commercial |
$493.92
|
| Rate for Payer: United Healthcare All Payer |
$452.76
|
|
|
PIGTAIL STR. 5F 110CM
|
Facility
|
OP
|
$514.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$493.92 |
| Rate for Payer: Aetna Commercial |
$396.16
|
| Rate for Payer: Anthem Medicaid |
$176.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.31
|
| Rate for Payer: Cash Price |
$257.25
|
| Rate for Payer: Cigna Commercial |
$427.04
|
| Rate for Payer: First Health Commercial |
$488.78
|
| Rate for Payer: Humana Commercial |
$437.32
|
| Rate for Payer: Humana KY Medicaid |
$176.94
|
| Rate for Payer: Kentucky WC Medicaid |
$178.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$421.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$379.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$452.76
|
| Rate for Payer: Ohio Health Group HMO |
$385.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.50
|
| Rate for Payer: PHCS Commercial |
$493.92
|
| Rate for Payer: United Healthcare All Payer |
$452.76
|
|
|
PILOCARPINE 1% EYE DROPS
|
Facility
|
OP
|
$1.03
|
|
|
Service Code
|
NDC 70069018101
|
| Hospital Charge Code |
25001186
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Anthem Medicaid |
$0.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: First Health Commercial |
$0.98
|
| Rate for Payer: Humana Commercial |
$0.88
|
| Rate for Payer: Humana KY Medicaid |
$0.35
|
| Rate for Payer: Kentucky WC Medicaid |
$0.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.91
|
| Rate for Payer: Ohio Health Group HMO |
$0.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.32
|
| Rate for Payer: PHCS Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Payer |
$0.91
|
|
|
PILOCARPINE 1% EYE DROPS
|
Facility
|
IP
|
$1.03
|
|
|
Service Code
|
NDC 70069018101
|
| Hospital Charge Code |
25001186
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Humana Commercial |
$0.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.91
|
| Rate for Payer: Ohio Health Group HMO |
$0.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.32
|
| Rate for Payer: PHCS Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Payer |
$0.91
|
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: First Health Commercial |
$0.98
|
|
|
PIN ACL TGHTROPE 4MM OPEN
|
Facility
|
OP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem Medicaid |
$614.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Humana KY Medicaid |
$614.72
|
| Rate for Payer: Kentucky WC Medicaid |
$620.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
PIN ACL TGHTROPE 4MM OPEN
|
Facility
|
IP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
PIN BUSHING ELBOW RPL KIT XSM
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
PIN BUSHING ELBOW RPL KIT XSM
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
PIN FINGER DISLOCATION
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 26776
|
| Hospital Charge Code |
76102603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.27 |
| Max. Negotiated Rate |
$700.72 |
| Rate for Payer: Aetna Commercial |
$618.54
|
| Rate for Payer: Anthem Medicaid |
$199.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$640.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$700.72
|
| Rate for Payer: Healthspan PPO |
$560.27
|
| Rate for Payer: Humana Medicaid |
$199.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$535.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.26
|
| Rate for Payer: Molina Healthcare Passport |
$199.27
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.00
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.26
|
|
|
PIN FINGER DISLOCATION
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 26776
|
| Hospital Charge Code |
76102603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.40
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
PIN FINGER DISLOCATION
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 26776
|
| Hospital Charge Code |
761P2603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.27 |
| Max. Negotiated Rate |
$700.72 |
| Rate for Payer: Aetna Commercial |
$618.54
|
| Rate for Payer: Anthem Medicaid |
$199.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$640.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$700.72
|
| Rate for Payer: Healthspan PPO |
$560.27
|
| Rate for Payer: Humana Medicaid |
$199.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$535.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.26
|
| Rate for Payer: Molina Healthcare Passport |
$199.27
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.00
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.26
|
|
|
PIN FINGER DISLOCATION
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 26776
|
| Hospital Charge Code |
76102603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem Medicaid |
$220.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Humana KY Medicaid |
$220.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$222.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.40
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
PIN GUIDE 3.2MMX343MM
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.12 |
| Max. Negotiated Rate |
$1,847.04 |
| Rate for Payer: Aetna Commercial |
$1,481.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.72
|
| Rate for Payer: Cash Price |
$962.00
|
| Rate for Payer: Cigna Commercial |
$1,596.92
|
| Rate for Payer: First Health Commercial |
$1,827.80
|
| Rate for Payer: Humana Commercial |
$1,635.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,693.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,443.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.44
|
| Rate for Payer: PHCS Commercial |
$1,847.04
|
| Rate for Payer: United Healthcare All Payer |
$1,693.12
|
|
|
PIN GUIDE 3.2MMX343MM
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.12 |
| Max. Negotiated Rate |
$1,847.04 |
| Rate for Payer: Aetna Commercial |
$1,481.48
|
| Rate for Payer: Anthem Medicaid |
$661.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.72
|
| Rate for Payer: Cash Price |
$962.00
|
| Rate for Payer: Cigna Commercial |
$1,596.92
|
| Rate for Payer: First Health Commercial |
$1,827.80
|
| Rate for Payer: Humana Commercial |
$1,635.40
|
| Rate for Payer: Humana KY Medicaid |
$661.66
|
| Rate for Payer: Kentucky WC Medicaid |
$668.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$674.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,693.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,443.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.44
|
| Rate for Payer: PHCS Commercial |
$1,847.04
|
| Rate for Payer: United Healthcare All Payer |
$1,693.12
|
|
