|
PAMELOR(NORTRIPTYLIN 10MG/1CAP
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 50268060315
|
| Hospital Charge Code |
25001154
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
|
|
PAMELOR(NORTRIPTYLIN 25MG/1CAP
|
Facility
|
OP
|
$4.62
|
|
|
Service Code
|
NDC 60687029301
|
| Hospital Charge Code |
25001155
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem Medicaid |
$1.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Humana KY Medicaid |
$1.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.19
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
PAMELOR(NORTRIPTYLIN 25MG/1CAP
|
Facility
|
IP
|
$4.62
|
|
|
Service Code
|
NDC 60687029301
|
| Hospital Charge Code |
25001155
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.19
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
PAMIDRONATE 30MG/10ML VIAL
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
25002300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.74
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.27
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
PAMIDRONATE 30MG/10ML VIAL
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS J2430
|
| Hospital Charge Code |
25002300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem Medicaid |
$62.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.74
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Humana KY Medicaid |
$62.93
|
| Rate for Payer: Kentucky WC Medicaid |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.27
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
PANALOK 3.5MM ABS ANCHOR
|
Facility
|
OP
|
$2,002.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.67 |
| Max. Negotiated Rate |
$1,922.15 |
| Rate for Payer: Aetna Commercial |
$1,541.72
|
| Rate for Payer: Anthem Medicaid |
$688.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,561.75
|
| Rate for Payer: Cash Price |
$1,001.12
|
| Rate for Payer: Cigna Commercial |
$1,661.86
|
| Rate for Payer: First Health Commercial |
$1,902.13
|
| Rate for Payer: Humana Commercial |
$1,701.90
|
| Rate for Payer: Humana KY Medicaid |
$688.57
|
| Rate for Payer: Kentucky WC Medicaid |
$695.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,641.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,477.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,761.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,501.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,601.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,741.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.55
|
| Rate for Payer: PHCS Commercial |
$1,922.15
|
| Rate for Payer: United Healthcare All Payer |
$1,761.97
|
|
|
PANALOK 3.5MM ABS ANCHOR
|
Facility
|
IP
|
$2,002.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.67 |
| Max. Negotiated Rate |
$1,922.15 |
| Rate for Payer: Aetna Commercial |
$1,541.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,561.75
|
| Rate for Payer: Cash Price |
$1,001.12
|
| Rate for Payer: Cigna Commercial |
$1,661.86
|
| Rate for Payer: First Health Commercial |
$1,902.13
|
| Rate for Payer: Humana Commercial |
$1,701.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,641.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,477.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,761.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,501.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,601.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,741.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,381.55
|
| Rate for Payer: PHCS Commercial |
$1,922.15
|
| Rate for Payer: United Healthcare All Payer |
$1,761.97
|
|
|
PANALOK RC QUICKANCHR SZ2 W/PA
|
Facility
|
IP
|
$1,951.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.36 |
| Max. Negotiated Rate |
$1,873.16 |
| Rate for Payer: Aetna Commercial |
$1,502.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.94
|
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Cigna Commercial |
$1,619.50
|
| Rate for Payer: First Health Commercial |
$1,853.65
|
| Rate for Payer: Humana Commercial |
$1,658.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,463.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,697.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,346.33
|
| Rate for Payer: PHCS Commercial |
$1,873.16
|
| Rate for Payer: United Healthcare All Payer |
$1,717.06
|
|
|
PANALOK RC QUICKANCHR SZ2 W/PA
|
Facility
|
OP
|
$1,951.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$585.36 |
| Max. Negotiated Rate |
$1,873.16 |
| Rate for Payer: Aetna Commercial |
$1,502.43
|
| Rate for Payer: Anthem Medicaid |
$671.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.94
|
| Rate for Payer: Cash Price |
$975.60
|
| Rate for Payer: Cigna Commercial |
$1,619.50
|
| Rate for Payer: First Health Commercial |
$1,853.65
|
| Rate for Payer: Humana Commercial |
$1,658.53
|
| Rate for Payer: Humana KY Medicaid |
$671.02
|
| Rate for Payer: Kentucky WC Medicaid |
$677.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,717.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,463.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,697.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,346.33
|
| Rate for Payer: PHCS Commercial |
$1,873.16
|
| Rate for Payer: United Healthcare All Payer |
$1,717.06
|
|
|
PANCREAS ULTRASOUND ONLY LTD
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem Medicaid |
$401.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Humana KY Medicaid |
$401.33
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$405.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
PANCREAS ULTRASOUND ONLY LTD
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
PANCREAS ULTRASOUND ONLY LTD
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$700.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$408.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
PANCREAS ULTRASOUND ONLY LTD(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402P0020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$157.49 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
PANCREAS ULTRASOUND ONLY LTD(T
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem Medicaid |
$358.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Humana KY Medicaid |
$358.34
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$361.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$365.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
PANCREAS ULTRASOUND ONLY LTD(T
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
PANCREATECTMY - DIISTL SUBT
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 48140
|
| Hospital Charge Code |
76101971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
PANCREATECTMY - DIISTL SUBT
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 48140
|
| Hospital Charge Code |
76101971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
PANCREATECTMY - DIISTL SUBT
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 48140
|
| Hospital Charge Code |
76101971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$2,248.40 |
| Rate for Payer: Aetna Commercial |
$2,248.40
|
| Rate for Payer: Ambetter Exchange |
$1,492.43
|
| Rate for Payer: Anthem Medicaid |
$961.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,492.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,492.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,790.92
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,086.00
|
| Rate for Payer: Healthspan PPO |
$1,896.12
|
| Rate for Payer: Humana Medicaid |
$961.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,994.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,492.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,492.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$980.57
|
| Rate for Payer: Molina Healthcare Passport |
$961.34
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,940.16
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$970.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,492.43
|
|
|
PANCREATECTMY - DIISTL SUBT(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 48140
|
| Hospital Charge Code |
761P1971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$2,248.40 |
| Rate for Payer: Aetna Commercial |
$2,248.40
|
| Rate for Payer: Ambetter Exchange |
$1,492.43
|
| Rate for Payer: Anthem Medicaid |
$961.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,492.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,492.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,790.92
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,086.00
|
| Rate for Payer: Healthspan PPO |
$1,896.12
|
| Rate for Payer: Humana Medicaid |
$961.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,994.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,492.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,492.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$980.57
|
| Rate for Payer: Molina Healthcare Passport |
$961.34
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,940.16
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$970.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,492.43
|
|
|
PANOPTIX LENS TFNT00+24.0
|
Facility
|
OP
|
$5,731.25
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,719.38 |
| Max. Negotiated Rate |
$5,502.00 |
| Rate for Payer: Aetna Commercial |
$4,413.06
|
| Rate for Payer: Anthem Medicaid |
$1,970.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,470.38
|
| Rate for Payer: Cash Price |
$2,865.62
|
| Rate for Payer: Cigna Commercial |
$4,756.94
|
| Rate for Payer: First Health Commercial |
$5,444.69
|
| Rate for Payer: Humana Commercial |
$4,871.56
|
| Rate for Payer: Humana KY Medicaid |
$1,970.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,991.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,699.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,229.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,719.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,010.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,043.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,298.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,986.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,954.56
|
| Rate for Payer: PHCS Commercial |
$5,502.00
|
| Rate for Payer: United Healthcare All Payer |
$5,043.50
|
|
|
PANOPTIX LENS TFNT00+24.0
|
Facility
|
IP
|
$5,731.25
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,719.38 |
| Max. Negotiated Rate |
$5,502.00 |
| Rate for Payer: Aetna Commercial |
$4,413.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,470.38
|
| Rate for Payer: Cash Price |
$2,865.62
|
| Rate for Payer: Cigna Commercial |
$4,756.94
|
| Rate for Payer: First Health Commercial |
$5,444.69
|
| Rate for Payer: Humana Commercial |
$4,871.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,699.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,229.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,719.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,043.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,298.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,986.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,954.56
|
| Rate for Payer: PHCS Commercial |
$5,502.00
|
| Rate for Payer: United Healthcare All Payer |
$5,043.50
|
|
|
PANOPTIX LENS TFNT30 +16.0
|
Facility
|
OP
|
$5,731.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,719.38 |
| Max. Negotiated Rate |
$5,502.00 |
| Rate for Payer: Aetna Commercial |
$4,413.06
|
| Rate for Payer: Anthem Medicaid |
$1,970.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,470.38
|
| Rate for Payer: Cash Price |
$2,865.62
|
| Rate for Payer: Cigna Commercial |
$4,756.94
|
| Rate for Payer: First Health Commercial |
$5,444.69
|
| Rate for Payer: Humana Commercial |
$4,871.56
|
| Rate for Payer: Humana KY Medicaid |
$1,970.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,991.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,699.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,229.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,719.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,010.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,043.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,298.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,986.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,954.56
|
| Rate for Payer: PHCS Commercial |
$5,502.00
|
| Rate for Payer: United Healthcare All Payer |
$5,043.50
|
|
|
PANOPTIX LENS TFNT30 +16.0
|
Facility
|
IP
|
$5,731.25
|
|
|
Service Code
|
HCPCS V2632
|
| Hospital Charge Code |
27000071
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,719.38 |
| Max. Negotiated Rate |
$5,502.00 |
| Rate for Payer: Aetna Commercial |
$4,413.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,470.38
|
| Rate for Payer: Cash Price |
$2,865.62
|
| Rate for Payer: Cigna Commercial |
$4,756.94
|
| Rate for Payer: First Health Commercial |
$5,444.69
|
| Rate for Payer: Humana Commercial |
$4,871.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,699.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,229.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,719.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,043.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,298.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,986.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,954.56
|
| Rate for Payer: PHCS Commercial |
$5,502.00
|
| Rate for Payer: United Healthcare All Payer |
$5,043.50
|
|
|
PANOPTIX LENS TFNT30(T)
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
PANOPTIX LENS TFNT30(T)
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
27000231
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
