|
PANTHERIS 7F
|
Facility
|
IP
|
$14,491.65
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,347.49 |
| Max. Negotiated Rate |
$13,911.98 |
| Rate for Payer: Aetna Commercial |
$11,158.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,303.49
|
| Rate for Payer: Cash Price |
$7,245.82
|
| Rate for Payer: Cigna Commercial |
$12,028.07
|
| Rate for Payer: First Health Commercial |
$13,767.07
|
| Rate for Payer: Humana Commercial |
$12,317.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,883.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,694.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,347.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,752.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,868.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,593.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,607.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,999.24
|
| Rate for Payer: PHCS Commercial |
$13,911.98
|
| Rate for Payer: United Healthcare All Payer |
$12,752.65
|
|
|
PANTHERIS 7F
|
Facility
|
OP
|
$14,491.65
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,347.49 |
| Max. Negotiated Rate |
$13,911.98 |
| Rate for Payer: Aetna Commercial |
$11,158.57
|
| Rate for Payer: Anthem Medicaid |
$4,983.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,303.49
|
| Rate for Payer: Cash Price |
$7,245.82
|
| Rate for Payer: Cigna Commercial |
$12,028.07
|
| Rate for Payer: First Health Commercial |
$13,767.07
|
| Rate for Payer: Humana Commercial |
$12,317.90
|
| Rate for Payer: Humana KY Medicaid |
$4,983.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,034.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,883.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,694.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,347.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,083.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,752.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,868.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,593.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,607.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,999.24
|
| Rate for Payer: PHCS Commercial |
$13,911.98
|
| Rate for Payer: United Healthcare All Payer |
$12,752.65
|
|
|
PANTHERIS 7F LONG NOSE CONE
|
Facility
|
OP
|
$14,491.65
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,347.49 |
| Max. Negotiated Rate |
$13,911.98 |
| Rate for Payer: Aetna Commercial |
$11,158.57
|
| Rate for Payer: Anthem Medicaid |
$4,983.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,303.49
|
| Rate for Payer: Cash Price |
$7,245.82
|
| Rate for Payer: Cigna Commercial |
$12,028.07
|
| Rate for Payer: First Health Commercial |
$13,767.07
|
| Rate for Payer: Humana Commercial |
$12,317.90
|
| Rate for Payer: Humana KY Medicaid |
$4,983.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,034.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,883.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,694.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,347.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,083.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,752.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,868.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,593.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,607.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,999.24
|
| Rate for Payer: PHCS Commercial |
$13,911.98
|
| Rate for Payer: United Healthcare All Payer |
$12,752.65
|
|
|
PANTHERIS 7F LONG NOSE CONE
|
Facility
|
IP
|
$14,491.65
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,347.49 |
| Max. Negotiated Rate |
$13,911.98 |
| Rate for Payer: Aetna Commercial |
$11,158.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,303.49
|
| Rate for Payer: Cash Price |
$7,245.82
|
| Rate for Payer: Cigna Commercial |
$12,028.07
|
| Rate for Payer: First Health Commercial |
$13,767.07
|
| Rate for Payer: Humana Commercial |
$12,317.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,883.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,694.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,347.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,752.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,868.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,593.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,607.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,999.24
|
| Rate for Payer: PHCS Commercial |
$13,911.98
|
| Rate for Payer: United Healthcare All Payer |
$12,752.65
|
|
|
PANTHERIS 8F
|
Facility
|
OP
|
$14,491.65
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,347.49 |
| Max. Negotiated Rate |
$13,911.98 |
| Rate for Payer: Aetna Commercial |
$11,158.57
|
| Rate for Payer: Anthem Medicaid |
$4,983.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,303.49
|
| Rate for Payer: Cash Price |
$7,245.82
|
| Rate for Payer: Cigna Commercial |
$12,028.07
|
| Rate for Payer: First Health Commercial |
$13,767.07
|
| Rate for Payer: Humana Commercial |
$12,317.90
|
| Rate for Payer: Humana KY Medicaid |
$4,983.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,034.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,883.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,694.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,347.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,083.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,752.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,868.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,593.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,607.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,999.24
|
| Rate for Payer: PHCS Commercial |
$13,911.98
|
| Rate for Payer: United Healthcare All Payer |
$12,752.65
|
|
|
PANTHERIS 8F
|
Facility
|
IP
|
$14,491.65
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,347.49 |
| Max. Negotiated Rate |
$13,911.98 |
| Rate for Payer: Aetna Commercial |
$11,158.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,303.49
|
| Rate for Payer: Cash Price |
$7,245.82
|
| Rate for Payer: Cigna Commercial |
$12,028.07
|
| Rate for Payer: First Health Commercial |
$13,767.07
|
| Rate for Payer: Humana Commercial |
$12,317.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,883.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,694.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,347.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,752.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,868.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,593.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,607.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,999.24
|
| Rate for Payer: PHCS Commercial |
$13,911.98
|
| Rate for Payer: United Healthcare All Payer |
$12,752.65
|
|
|
PANTHERIS SLED
|
Facility
|
IP
|
$27,481.25
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,244.38 |
| Max. Negotiated Rate |
$26,382.00 |
| Rate for Payer: Aetna Commercial |
$21,160.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,435.38
|
| Rate for Payer: Cash Price |
$13,740.62
|
| Rate for Payer: Cigna Commercial |
$22,809.44
|
| Rate for Payer: First Health Commercial |
$26,107.19
|
| Rate for Payer: Humana Commercial |
$23,359.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,534.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,281.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,244.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,183.50
|
| Rate for Payer: Ohio Health Group HMO |
$20,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,908.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,962.06
|
| Rate for Payer: PHCS Commercial |
$26,382.00
|
| Rate for Payer: United Healthcare All Payer |
$24,183.50
|
|
|
PANTHERIS SLED
|
Facility
|
OP
|
$27,481.25
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,244.38 |
| Max. Negotiated Rate |
$26,382.00 |
| Rate for Payer: Aetna Commercial |
$21,160.56
|
| Rate for Payer: Anthem Medicaid |
$9,450.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,435.38
|
| Rate for Payer: Cash Price |
$13,740.62
|
| Rate for Payer: Cigna Commercial |
$22,809.44
|
| Rate for Payer: First Health Commercial |
$26,107.19
|
| Rate for Payer: Humana Commercial |
$23,359.06
|
| Rate for Payer: Humana KY Medicaid |
$9,450.80
|
| Rate for Payer: Kentucky WC Medicaid |
$9,546.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,534.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,281.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,244.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,640.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,183.50
|
| Rate for Payer: Ohio Health Group HMO |
$20,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,908.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,962.06
|
| Rate for Payer: PHCS Commercial |
$26,382.00
|
| Rate for Payer: United Healthcare All Payer |
$24,183.50
|
|
|
PANTHERIS SV 6F
|
Facility
|
IP
|
$14,491.65
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,347.49 |
| Max. Negotiated Rate |
$13,911.98 |
| Rate for Payer: Aetna Commercial |
$11,158.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,303.49
|
| Rate for Payer: Cash Price |
$7,245.82
|
| Rate for Payer: Cigna Commercial |
$12,028.07
|
| Rate for Payer: First Health Commercial |
$13,767.07
|
| Rate for Payer: Humana Commercial |
$12,317.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,883.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,694.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,347.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,752.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,868.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,593.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,607.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,999.24
|
| Rate for Payer: PHCS Commercial |
$13,911.98
|
| Rate for Payer: United Healthcare All Payer |
$12,752.65
|
|
|
PANTHERIS SV 6F
|
Facility
|
OP
|
$14,491.65
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27000006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,347.49 |
| Max. Negotiated Rate |
$13,911.98 |
| Rate for Payer: Aetna Commercial |
$11,158.57
|
| Rate for Payer: Anthem Medicaid |
$4,983.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,303.49
|
| Rate for Payer: Cash Price |
$7,245.82
|
| Rate for Payer: Cigna Commercial |
$12,028.07
|
| Rate for Payer: First Health Commercial |
$13,767.07
|
| Rate for Payer: Humana Commercial |
$12,317.90
|
| Rate for Payer: Humana KY Medicaid |
$4,983.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,034.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,883.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,694.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,347.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,083.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,752.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,868.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,593.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,607.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,999.24
|
| Rate for Payer: PHCS Commercial |
$13,911.98
|
| Rate for Payer: United Healthcare All Payer |
$12,752.65
|
|
|
PAPAVERINE 60MG/2ML VIAL
|
Facility
|
IP
|
$204.38
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
25002301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.31 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna Commercial |
$157.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.42
|
| Rate for Payer: Cash Price |
$102.19
|
| Rate for Payer: Cigna Commercial |
$169.64
|
| Rate for Payer: First Health Commercial |
$194.16
|
| Rate for Payer: Humana Commercial |
$173.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.85
|
| Rate for Payer: Ohio Health Group HMO |
$153.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.02
|
| Rate for Payer: PHCS Commercial |
$196.20
|
| Rate for Payer: United Healthcare All Payer |
$179.85
|
|
|
PAPAVERINE 60MG/2ML VIAL
|
Facility
|
OP
|
$204.38
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
25002301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.31 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Aetna Commercial |
$157.37
|
| Rate for Payer: Anthem Medicaid |
$70.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.42
|
| Rate for Payer: Cash Price |
$102.19
|
| Rate for Payer: Cigna Commercial |
$169.64
|
| Rate for Payer: First Health Commercial |
$194.16
|
| Rate for Payer: Humana Commercial |
$173.72
|
| Rate for Payer: Humana KY Medicaid |
$70.29
|
| Rate for Payer: Kentucky WC Medicaid |
$71.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.85
|
| Rate for Payer: Ohio Health Group HMO |
$153.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.02
|
| Rate for Payer: PHCS Commercial |
$196.20
|
| Rate for Payer: United Healthcare All Payer |
$179.85
|
|
|
PAPER PATCH MYRINGOPLASTY
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 69610
|
| Hospital Charge Code |
76102428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.91 |
| Max. Negotiated Rate |
$492.23 |
| Rate for Payer: Aetna Commercial |
$433.42
|
| Rate for Payer: Ambetter Exchange |
$270.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$146.91
|
| Rate for Payer: Anthem Medicaid |
$155.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$270.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$270.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$325.06
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$434.65
|
| Rate for Payer: Healthspan PPO |
$492.23
|
| Rate for Payer: Humana Medicaid |
$155.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$379.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$270.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$159.02
|
| Rate for Payer: Molina Healthcare Passport |
$155.90
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$352.14
|
| Rate for Payer: UHCCP Medicaid |
$154.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$157.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$270.88
|
|
|
PAPER PATCH MYRINGOPLASTY
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 69610
|
| Hospital Charge Code |
76102428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.15 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.15
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
PAPER PATCH MYRINGOPLASTY
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 69610
|
| Hospital Charge Code |
76102428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
PAPER PATCH MYRINGOPLASTY(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 69610
|
| Hospital Charge Code |
761P2428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.91 |
| Max. Negotiated Rate |
$492.23 |
| Rate for Payer: Aetna Commercial |
$433.42
|
| Rate for Payer: Ambetter Exchange |
$270.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$146.91
|
| Rate for Payer: Anthem Medicaid |
$155.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$270.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$270.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$325.06
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$434.65
|
| Rate for Payer: Healthspan PPO |
$492.23
|
| Rate for Payer: Humana Medicaid |
$155.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$379.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$270.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$159.02
|
| Rate for Payer: Molina Healthcare Passport |
$155.90
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$352.14
|
| Rate for Payer: UHCCP Medicaid |
$154.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$157.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$270.88
|
|
|
PARACENTESIS WITH IMAGING
|
Facility
|
IP
|
$2,851.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
76102767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$855.30 |
| Max. Negotiated Rate |
$2,736.96 |
| Rate for Payer: Aetna Commercial |
$2,195.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.78
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$2,366.33
|
| Rate for Payer: First Health Commercial |
$2,708.45
|
| Rate for Payer: Humana Commercial |
$2,423.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,104.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,480.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,967.19
|
| Rate for Payer: PHCS Commercial |
$2,736.96
|
| Rate for Payer: United Healthcare All Payer |
$2,508.88
|
|
|
PARACENTESIS WITH IMAGING
|
Professional
|
Both
|
$2,851.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
76102767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$1,710.60 |
| Rate for Payer: Ambetter Exchange |
$99.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.65
|
| Rate for Payer: Anthem Medicaid |
$240.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.24
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$182.46
|
| Rate for Payer: Healthspan PPO |
$287.25
|
| Rate for Payer: Humana Medicaid |
$240.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$99.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$245.01
|
| Rate for Payer: Molina Healthcare Passport |
$240.21
|
| Rate for Payer: Multiplan PHCS |
$1,710.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.18
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$242.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.37
|
|
|
PARACENTESIS WITH IMAGING
|
Facility
|
OP
|
$2,851.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
76102767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.29 |
| Max. Negotiated Rate |
$2,736.96 |
| Rate for Payer: Aetna Commercial |
$2,195.27
|
| Rate for Payer: Anthem Medicaid |
$980.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cash Price |
$1,425.50
|
| Rate for Payer: Cigna Commercial |
$2,366.33
|
| Rate for Payer: First Health Commercial |
$2,708.45
|
| Rate for Payer: Humana Commercial |
$2,423.35
|
| Rate for Payer: Humana KY Medicaid |
$980.46
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$990.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,104.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,000.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,138.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,480.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,967.19
|
| Rate for Payer: PHCS Commercial |
$2,736.96
|
| Rate for Payer: United Healthcare All Payer |
$2,508.88
|
|
|
PARACENTESIS WITH IMAGING (P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
761P2767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Ambetter Exchange |
$99.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.65
|
| Rate for Payer: Anthem Medicaid |
$240.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.24
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$182.46
|
| Rate for Payer: Healthspan PPO |
$287.25
|
| Rate for Payer: Humana Medicaid |
$240.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$99.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$245.01
|
| Rate for Payer: Molina Healthcare Passport |
$240.21
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.18
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$242.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.37
|
|
|
PARACENTESIS WITH IMAGING (T
|
Facility
|
OP
|
$2,251.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
761T2767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$774.12 |
| Max. Negotiated Rate |
$2,160.96 |
| Rate for Payer: Aetna Commercial |
$1,733.27
|
| Rate for Payer: Anthem Medicaid |
$774.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$1,125.50
|
| Rate for Payer: Cash Price |
$1,125.50
|
| Rate for Payer: Cigna Commercial |
$1,868.33
|
| Rate for Payer: First Health Commercial |
$2,138.45
|
| Rate for Payer: Humana Commercial |
$1,913.35
|
| Rate for Payer: Humana KY Medicaid |
$774.12
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$782.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,661.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$789.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,688.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,800.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,958.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.19
|
| Rate for Payer: PHCS Commercial |
$2,160.96
|
| Rate for Payer: United Healthcare All Payer |
$1,980.88
|
|
|
PARACENTESIS WITH IMAGING (T
|
Facility
|
IP
|
$2,251.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
761T2767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$675.30 |
| Max. Negotiated Rate |
$2,160.96 |
| Rate for Payer: Aetna Commercial |
$1,733.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.78
|
| Rate for Payer: Cash Price |
$1,125.50
|
| Rate for Payer: Cigna Commercial |
$1,868.33
|
| Rate for Payer: First Health Commercial |
$2,138.45
|
| Rate for Payer: Humana Commercial |
$1,913.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,661.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,688.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,800.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,958.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.19
|
| Rate for Payer: PHCS Commercial |
$2,160.96
|
| Rate for Payer: United Healthcare All Payer |
$1,980.88
|
|
|
PARAFFIN BATH
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 97018
|
| Hospital Charge Code |
43000006
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem Medicaid |
$31.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.98
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Humana KY Medicaid |
$31.29
|
| Rate for Payer: Kentucky WC Medicaid |
$31.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.79
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
PARAFFIN BATH
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 97018
|
| Hospital Charge Code |
43000006
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.98
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.79
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
PARAFFIN BATH
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 97018
|
| Hospital Charge Code |
42000009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$85.44 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Anthem Medicaid |
$30.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.42
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$73.87
|
| Rate for Payer: First Health Commercial |
$84.55
|
| Rate for Payer: Humana Commercial |
$75.65
|
| Rate for Payer: Humana KY Medicaid |
$30.61
|
| Rate for Payer: Kentucky WC Medicaid |
$30.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$78.32
|
| Rate for Payer: Ohio Health Group HMO |
$66.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.41
|
| Rate for Payer: PHCS Commercial |
$85.44
|
| Rate for Payer: United Healthcare All Payer |
$78.32
|
|
