|
PACIFIC PLUS BALLOON 6*20*180
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
PACIFIC PLUS BALLOON 6*20*180
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem Medicaid |
$734.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Humana KY Medicaid |
$734.57
|
| Rate for Payer: Kentucky WC Medicaid |
$742.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
PACIFIC PLUS BALLOON 6*40*180
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem Medicaid |
$734.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Humana KY Medicaid |
$734.57
|
| Rate for Payer: Kentucky WC Medicaid |
$742.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
PACIFIC PLUS BALLOON 6*40*180
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
PACIFIC PLUS BALLOON 7*20*180
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem Medicaid |
$734.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Humana KY Medicaid |
$734.57
|
| Rate for Payer: Kentucky WC Medicaid |
$742.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
PACIFIC PLUS BALLOON 7*20*180
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
PACIFIC PLUS BALLOON 7*40*180
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem Medicaid |
$734.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Humana KY Medicaid |
$734.57
|
| Rate for Payer: Kentucky WC Medicaid |
$742.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
PACIFIC PLUS BALLOON 7*40*180
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
PACING CABLE SCREW IN FL-601-9
|
Facility
|
IP
|
$500.40
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$150.12 |
| Max. Negotiated Rate |
$480.38 |
| Rate for Payer: Aetna Commercial |
$385.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.31
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$415.33
|
| Rate for Payer: First Health Commercial |
$475.38
|
| Rate for Payer: Humana Commercial |
$425.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.35
|
| Rate for Payer: Ohio Health Group HMO |
$375.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.28
|
| Rate for Payer: PHCS Commercial |
$480.38
|
| Rate for Payer: United Healthcare All Payer |
$440.35
|
|
|
PACING CABLE SCREW IN FL-601-9
|
Facility
|
OP
|
$500.40
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$150.12 |
| Max. Negotiated Rate |
$480.38 |
| Rate for Payer: Aetna Commercial |
$385.31
|
| Rate for Payer: Anthem Medicaid |
$172.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.31
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$415.33
|
| Rate for Payer: First Health Commercial |
$475.38
|
| Rate for Payer: Humana Commercial |
$425.34
|
| Rate for Payer: Humana KY Medicaid |
$172.09
|
| Rate for Payer: Kentucky WC Medicaid |
$173.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.35
|
| Rate for Payer: Ohio Health Group HMO |
$375.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.28
|
| Rate for Payer: PHCS Commercial |
$480.38
|
| Rate for Payer: United Healthcare All Payer |
$440.35
|
|
|
PACING CABLE SCRW IN FL-601-97
|
Facility
|
IP
|
$505.87
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$151.76 |
| Max. Negotiated Rate |
$485.64 |
| Rate for Payer: Aetna Commercial |
$389.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$394.58
|
| Rate for Payer: Cash Price |
$252.94
|
| Rate for Payer: Cigna Commercial |
$419.87
|
| Rate for Payer: First Health Commercial |
$480.58
|
| Rate for Payer: Humana Commercial |
$429.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.17
|
| Rate for Payer: Ohio Health Group HMO |
$379.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.05
|
| Rate for Payer: PHCS Commercial |
$485.64
|
| Rate for Payer: United Healthcare All Payer |
$445.17
|
|
|
PACING CABLE SCRW IN FL-601-97
|
Facility
|
OP
|
$505.87
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
27000061
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$151.76 |
| Max. Negotiated Rate |
$485.64 |
| Rate for Payer: Aetna Commercial |
$389.52
|
| Rate for Payer: Anthem Medicaid |
$173.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$394.58
|
| Rate for Payer: Cash Price |
$252.94
|
| Rate for Payer: Cigna Commercial |
$419.87
|
| Rate for Payer: First Health Commercial |
$480.58
|
| Rate for Payer: Humana Commercial |
$429.99
|
| Rate for Payer: Humana KY Medicaid |
$173.97
|
| Rate for Payer: Kentucky WC Medicaid |
$175.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.17
|
| Rate for Payer: Ohio Health Group HMO |
$379.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.05
|
| Rate for Payer: PHCS Commercial |
$485.64
|
| Rate for Payer: United Healthcare All Payer |
$445.17
|
|
|
PACLITAXEL 1MG (FROM 100MG MDV
|
Facility
|
OP
|
$2.34
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
25004033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Anthem Medicaid |
$0.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.83
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna Commercial |
$1.94
|
| Rate for Payer: First Health Commercial |
$2.22
|
| Rate for Payer: Humana Commercial |
$1.99
|
| Rate for Payer: Humana KY Medicaid |
$0.80
|
| Rate for Payer: Kentucky WC Medicaid |
$0.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.06
|
| Rate for Payer: Ohio Health Group HMO |
$1.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.61
|
| Rate for Payer: PHCS Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Payer |
$2.06
|
|
|
PACLITAXEL 1MG (FROM 100MG MDV
|
Facility
|
IP
|
$2.34
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
25004033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.83
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna Commercial |
$1.94
|
| Rate for Payer: First Health Commercial |
$2.22
|
| Rate for Payer: Humana Commercial |
$1.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.06
|
| Rate for Payer: Ohio Health Group HMO |
$1.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.61
|
| Rate for Payer: PHCS Commercial |
$2.25
|
| Rate for Payer: United Healthcare All Payer |
$2.06
|
|
|
PACLITAXEL 1MG (FROM 300MG MDV
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
25004034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.40
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$1.49
|
| Rate for Payer: First Health Commercial |
$1.71
|
| Rate for Payer: Humana Commercial |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.58
|
| Rate for Payer: Ohio Health Group HMO |
$1.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.24
|
| Rate for Payer: PHCS Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Payer |
$1.58
|
|
|
PACLITAXEL 1MG (FROM 300MG MDV
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
25004034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Anthem Medicaid |
$0.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.40
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$1.49
|
| Rate for Payer: First Health Commercial |
$1.71
|
| Rate for Payer: Humana Commercial |
$1.53
|
| Rate for Payer: Humana KY Medicaid |
$0.62
|
| Rate for Payer: Kentucky WC Medicaid |
$0.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.58
|
| Rate for Payer: Ohio Health Group HMO |
$1.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.24
|
| Rate for Payer: PHCS Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Payer |
$1.58
|
|
|
PACLITAXEL 1MG (FROM 30MG MDV)
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
25004032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.40
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$1.49
|
| Rate for Payer: First Health Commercial |
$1.71
|
| Rate for Payer: Humana Commercial |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.58
|
| Rate for Payer: Ohio Health Group HMO |
$1.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.24
|
| Rate for Payer: PHCS Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Payer |
$1.58
|
|
|
PACLITAXEL 1MG (FROM 30MG MDV)
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
25004032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Anthem Medicaid |
$0.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.40
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$1.49
|
| Rate for Payer: First Health Commercial |
$1.71
|
| Rate for Payer: Humana Commercial |
$1.53
|
| Rate for Payer: Humana KY Medicaid |
$0.62
|
| Rate for Payer: Kentucky WC Medicaid |
$0.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.58
|
| Rate for Payer: Ohio Health Group HMO |
$1.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.24
|
| Rate for Payer: PHCS Commercial |
$1.73
|
| Rate for Payer: United Healthcare All Payer |
$1.58
|
|
|
PACU CRITICAL CARE ROOM RATE
|
Facility
|
IP
|
$3,658.00
|
|
| Hospital Charge Code |
20000004
|
|
Hospital Revenue Code
|
150
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: Aetna Commercial |
$2,816.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,853.24
|
| Rate for Payer: Cash Price |
$1,829.00
|
| Rate for Payer: Cigna Commercial |
$3,036.14
|
| Rate for Payer: First Health Commercial |
$3,475.10
|
| Rate for Payer: Humana Commercial |
$3,109.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,999.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,699.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,219.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,743.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,926.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,182.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,524.02
|
| Rate for Payer: PHCS Commercial |
$3,511.68
|
| Rate for Payer: United Healthcare All Payer |
$3,219.04
|
|
|
Padcev 0.25mg (20mg/10mLV)
|
Facility
|
OP
|
$15,309.05
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
25004010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.66 |
| Max. Negotiated Rate |
$14,696.69 |
| Rate for Payer: Aetna Commercial |
$11,787.97
|
| Rate for Payer: Anthem Medicaid |
$5,264.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$36.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,941.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$51.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.49
|
| Rate for Payer: Cash Price |
$7,654.52
|
| Rate for Payer: Cash Price |
$7,654.52
|
| Rate for Payer: Cigna Commercial |
$12,706.51
|
| Rate for Payer: First Health Commercial |
$14,543.60
|
| Rate for Payer: Humana Commercial |
$13,012.69
|
| Rate for Payer: Humana KY Medicaid |
$5,264.78
|
| Rate for Payer: Humana Medicare Advantage |
$36.66
|
| Rate for Payer: Kentucky WC Medicaid |
$5,318.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,553.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,298.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,370.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,471.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,481.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,247.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,318.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,563.24
|
| Rate for Payer: PHCS Commercial |
$14,696.69
|
| Rate for Payer: United Healthcare All Payer |
$13,471.96
|
|
|
Padcev 0.25mg (20mg/10mLV)
|
Facility
|
IP
|
$15,309.05
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
25004010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,592.72 |
| Max. Negotiated Rate |
$14,696.69 |
| Rate for Payer: Aetna Commercial |
$11,787.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,941.06
|
| Rate for Payer: Cash Price |
$7,654.52
|
| Rate for Payer: Cigna Commercial |
$12,706.51
|
| Rate for Payer: First Health Commercial |
$14,543.60
|
| Rate for Payer: Humana Commercial |
$13,012.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,553.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,298.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,592.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,471.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,481.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,247.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,318.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,563.24
|
| Rate for Payer: PHCS Commercial |
$14,696.69
|
| Rate for Payer: United Healthcare All Payer |
$13,471.96
|
|
|
Padcev 0.25mg(30mg/10mLV)
|
Facility
|
IP
|
$22,963.58
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
25004011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,889.07 |
| Max. Negotiated Rate |
$22,045.04 |
| Rate for Payer: Aetna Commercial |
$17,681.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,911.59
|
| Rate for Payer: Cash Price |
$11,481.79
|
| Rate for Payer: Cigna Commercial |
$19,059.77
|
| Rate for Payer: First Health Commercial |
$21,815.40
|
| Rate for Payer: Humana Commercial |
$19,519.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,830.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,947.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,889.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,207.95
|
| Rate for Payer: Ohio Health Group HMO |
$17,222.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,370.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,978.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,844.87
|
| Rate for Payer: PHCS Commercial |
$22,045.04
|
| Rate for Payer: United Healthcare All Payer |
$20,207.95
|
|
|
Padcev 0.25mg(30mg/10mLV)
|
Facility
|
OP
|
$22,963.58
|
|
|
Service Code
|
HCPCS J9177
|
| Hospital Charge Code |
25004011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.66 |
| Max. Negotiated Rate |
$22,045.04 |
| Rate for Payer: Aetna Commercial |
$17,681.96
|
| Rate for Payer: Anthem Medicaid |
$7,897.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$36.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,911.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$51.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.49
|
| Rate for Payer: Cash Price |
$11,481.79
|
| Rate for Payer: Cash Price |
$11,481.79
|
| Rate for Payer: Cigna Commercial |
$19,059.77
|
| Rate for Payer: First Health Commercial |
$21,815.40
|
| Rate for Payer: Humana Commercial |
$19,519.04
|
| Rate for Payer: Humana KY Medicaid |
$7,897.18
|
| Rate for Payer: Humana Medicare Advantage |
$36.66
|
| Rate for Payer: Kentucky WC Medicaid |
$7,977.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,830.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,947.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,207.95
|
| Rate for Payer: Ohio Health Group HMO |
$17,222.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,370.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,978.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,844.87
|
| Rate for Payer: PHCS Commercial |
$22,045.04
|
| Rate for Payer: United Healthcare All Payer |
$20,207.95
|
|
|
PAD REHAB PER SESSION
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 93668
|
| Hospital Charge Code |
48000057
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$33.01 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem Medicaid |
$33.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Humana KY Medicaid |
$33.01
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$33.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.24
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
PAD REHAB PER SESSION
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 93668
|
| Hospital Charge Code |
48000057
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.88
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.24
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
