|
PERC NEPH PLACEMENT
|
Professional
|
Both
|
$3,147.00
|
|
|
Service Code
|
HCPCS 50432
|
| Hospital Charge Code |
76102048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$1,888.20 |
| Rate for Payer: Ambetter Exchange |
$190.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$178.65
|
| Rate for Payer: Anthem Medicaid |
$634.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.23
|
| Rate for Payer: Cash Price |
$1,573.50
|
| Rate for Payer: Cash Price |
$1,573.50
|
| Rate for Payer: Cigna Commercial |
$369.04
|
| Rate for Payer: Humana Medicaid |
$634.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$301.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$647.64
|
| Rate for Payer: Molina Healthcare Passport |
$634.94
|
| Rate for Payer: Multiplan PHCS |
$1,888.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.25
|
| Rate for Payer: UHCCP Medicaid |
$187.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$641.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.19
|
|
|
PERC NEPH PLACEMENT
|
Facility
|
OP
|
$3,147.00
|
|
|
Service Code
|
HCPCS 50432
|
| Hospital Charge Code |
76102048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,082.25 |
| Max. Negotiated Rate |
$3,021.12 |
| Rate for Payer: Aetna Commercial |
$2,423.19
|
| Rate for Payer: Anthem Medicaid |
$1,082.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,454.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$1,573.50
|
| Rate for Payer: Cash Price |
$1,573.50
|
| Rate for Payer: Cigna Commercial |
$2,612.01
|
| Rate for Payer: First Health Commercial |
$2,989.65
|
| Rate for Payer: Humana Commercial |
$2,674.95
|
| Rate for Payer: Humana KY Medicaid |
$1,082.25
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,103.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,517.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,737.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.43
|
| Rate for Payer: PHCS Commercial |
$3,021.12
|
| Rate for Payer: United Healthcare All Payer |
$2,769.36
|
|
|
PERC NEPH PLACEMENT
|
Facility
|
IP
|
$3,147.00
|
|
|
Service Code
|
HCPCS 50432
|
| Hospital Charge Code |
76102048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$944.10 |
| Max. Negotiated Rate |
$3,021.12 |
| Rate for Payer: Aetna Commercial |
$2,423.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,454.66
|
| Rate for Payer: Cash Price |
$1,573.50
|
| Rate for Payer: Cigna Commercial |
$2,612.01
|
| Rate for Payer: First Health Commercial |
$2,989.65
|
| Rate for Payer: Humana Commercial |
$2,674.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,517.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,737.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.43
|
| Rate for Payer: PHCS Commercial |
$3,021.12
|
| Rate for Payer: United Healthcare All Payer |
$2,769.36
|
|
|
PERC NEPH PLACEMENT(P
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 50432
|
| Hospital Charge Code |
761P2048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$647.64 |
| Rate for Payer: Ambetter Exchange |
$190.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$178.65
|
| Rate for Payer: Anthem Medicaid |
$634.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.23
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$369.04
|
| Rate for Payer: Humana Medicaid |
$634.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$301.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$647.64
|
| Rate for Payer: Molina Healthcare Passport |
$634.94
|
| Rate for Payer: Multiplan PHCS |
$366.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.25
|
| Rate for Payer: UHCCP Medicaid |
$187.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$641.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.19
|
|
|
PERC NEPH PLACEMENT(T
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 50432
|
| Hospital Charge Code |
761T2048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem Medicaid |
$872.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Humana KY Medicaid |
$872.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$881.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$889.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,029.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,207.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.53
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
PERC NEPH PLACEMENT(T
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 50432
|
| Hospital Charge Code |
761T2048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$761.10 |
| Max. Negotiated Rate |
$2,435.52 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$761.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,029.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,207.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.53
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
PERCOCET 10/325MG TABLET
|
Facility
|
OP
|
$61.72
|
|
|
Service Code
|
NDC 68084071001
|
| Hospital Charge Code |
25003349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Aetna Commercial |
$47.52
|
| Rate for Payer: Anthem Medicaid |
$21.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.14
|
| Rate for Payer: Cash Price |
$30.86
|
| Rate for Payer: Cigna Commercial |
$51.23
|
| Rate for Payer: First Health Commercial |
$58.63
|
| Rate for Payer: Humana Commercial |
$52.46
|
| Rate for Payer: Humana KY Medicaid |
$21.23
|
| Rate for Payer: Kentucky WC Medicaid |
$21.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.31
|
| Rate for Payer: Ohio Health Group HMO |
$46.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.59
|
| Rate for Payer: PHCS Commercial |
$59.25
|
| Rate for Payer: United Healthcare All Payer |
$54.31
|
|
|
PERCOCET 10/325MG TABLET
|
Facility
|
IP
|
$61.72
|
|
|
Service Code
|
NDC 68084071001
|
| Hospital Charge Code |
25003349
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Aetna Commercial |
$47.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.14
|
| Rate for Payer: Cash Price |
$30.86
|
| Rate for Payer: Cigna Commercial |
$51.23
|
| Rate for Payer: First Health Commercial |
$58.63
|
| Rate for Payer: Humana Commercial |
$52.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.31
|
| Rate for Payer: Ohio Health Group HMO |
$46.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.59
|
| Rate for Payer: PHCS Commercial |
$59.25
|
| Rate for Payer: United Healthcare All Payer |
$54.31
|
|
|
PERCOCET 7.5/325MG TABLET
|
Facility
|
OP
|
$60.15
|
|
|
Service Code
|
NDC 13107004501
|
| Hospital Charge Code |
25001174
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Anthem Medicaid |
$20.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.92
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cigna Commercial |
$49.92
|
| Rate for Payer: First Health Commercial |
$57.14
|
| Rate for Payer: Humana Commercial |
$51.13
|
| Rate for Payer: Humana KY Medicaid |
$20.69
|
| Rate for Payer: Kentucky WC Medicaid |
$20.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.93
|
| Rate for Payer: Ohio Health Group HMO |
$45.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.50
|
| Rate for Payer: PHCS Commercial |
$57.74
|
| Rate for Payer: United Healthcare All Payer |
$52.93
|
|
|
PERCOCET 7.5/325MG TABLET
|
Facility
|
IP
|
$60.15
|
|
|
Service Code
|
NDC 13107004501
|
| Hospital Charge Code |
25001174
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$46.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.92
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cigna Commercial |
$49.92
|
| Rate for Payer: First Health Commercial |
$57.14
|
| Rate for Payer: Humana Commercial |
$51.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.93
|
| Rate for Payer: Ohio Health Group HMO |
$45.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.50
|
| Rate for Payer: PHCS Commercial |
$57.74
|
| Rate for Payer: United Healthcare All Payer |
$52.93
|
|
|
PERC PORTAL VEINCATH ANYMETHOD
|
Facility
|
IP
|
$3,241.14
|
|
|
Service Code
|
HCPCS 36481
|
| Hospital Charge Code |
76101467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$972.34 |
| Max. Negotiated Rate |
$3,111.49 |
| Rate for Payer: Aetna Commercial |
$2,495.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,528.09
|
| Rate for Payer: Cash Price |
$1,620.57
|
| Rate for Payer: Cigna Commercial |
$2,690.15
|
| Rate for Payer: First Health Commercial |
$3,079.08
|
| Rate for Payer: Humana Commercial |
$2,754.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,657.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,391.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$972.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,852.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,430.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,592.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,819.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,236.39
|
| Rate for Payer: PHCS Commercial |
$3,111.49
|
| Rate for Payer: United Healthcare All Payer |
$2,852.20
|
|
|
PERC PORTAL VEINCATH ANYMETHOD
|
Facility
|
OP
|
$3,241.14
|
|
|
Service Code
|
HCPCS 36481
|
| Hospital Charge Code |
76101467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$972.34 |
| Max. Negotiated Rate |
$3,111.49 |
| Rate for Payer: Aetna Commercial |
$2,495.68
|
| Rate for Payer: Anthem Medicaid |
$1,114.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,528.09
|
| Rate for Payer: Cash Price |
$1,620.57
|
| Rate for Payer: Cigna Commercial |
$2,690.15
|
| Rate for Payer: First Health Commercial |
$3,079.08
|
| Rate for Payer: Humana Commercial |
$2,754.97
|
| Rate for Payer: Humana KY Medicaid |
$1,114.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,125.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,657.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,391.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$972.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,136.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,852.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,430.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,592.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,819.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,236.39
|
| Rate for Payer: PHCS Commercial |
$3,111.49
|
| Rate for Payer: United Healthcare All Payer |
$2,852.20
|
|
|
PERC PORTAL VEINCATH ANYMETHOD
|
Facility
|
OP
|
$2,701.14
|
|
|
Service Code
|
HCPCS 36481
|
| Hospital Charge Code |
761T1467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.34 |
| Max. Negotiated Rate |
$2,593.09 |
| Rate for Payer: Aetna Commercial |
$2,079.88
|
| Rate for Payer: Anthem Medicaid |
$928.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.89
|
| Rate for Payer: Cash Price |
$1,350.57
|
| Rate for Payer: Cigna Commercial |
$2,241.95
|
| Rate for Payer: First Health Commercial |
$2,566.08
|
| Rate for Payer: Humana Commercial |
$2,295.97
|
| Rate for Payer: Humana KY Medicaid |
$928.92
|
| Rate for Payer: Kentucky WC Medicaid |
$938.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,993.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.79
|
| Rate for Payer: PHCS Commercial |
$2,593.09
|
| Rate for Payer: United Healthcare All Payer |
$2,377.00
|
|
|
PERC PORTAL VEINCATH ANYMETHOD
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 36481
|
| Hospital Charge Code |
761P1467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$647.10 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Ambetter Exchange |
$302.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.76
|
| Rate for Payer: Anthem Medicaid |
$362.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$302.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$302.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$363.25
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$537.59
|
| Rate for Payer: Healthspan PPO |
$517.41
|
| Rate for Payer: Humana Medicaid |
$362.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$464.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$302.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.33
|
| Rate for Payer: Molina Healthcare Passport |
$362.09
|
| Rate for Payer: Multiplan PHCS |
$324.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$393.52
|
| Rate for Payer: UHCCP Medicaid |
$266.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$365.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$302.71
|
|
|
PERC PORTAL VEINCATH ANYMETHOD
|
Facility
|
IP
|
$2,701.14
|
|
|
Service Code
|
HCPCS 36481
|
| Hospital Charge Code |
761T1467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.34 |
| Max. Negotiated Rate |
$2,593.09 |
| Rate for Payer: Aetna Commercial |
$2,079.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.89
|
| Rate for Payer: Cash Price |
$1,350.57
|
| Rate for Payer: Cigna Commercial |
$2,241.95
|
| Rate for Payer: First Health Commercial |
$2,566.08
|
| Rate for Payer: Humana Commercial |
$2,295.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,993.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.79
|
| Rate for Payer: PHCS Commercial |
$2,593.09
|
| Rate for Payer: United Healthcare All Payer |
$2,377.00
|
|
|
PERC PORTAL VEINCATH ANYMETHOD
|
Professional
|
Both
|
$3,241.14
|
|
|
Service Code
|
HCPCS 36481
|
| Hospital Charge Code |
76101467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$1,944.68 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Ambetter Exchange |
$302.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.76
|
| Rate for Payer: Anthem Medicaid |
$362.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$302.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$302.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$363.25
|
| Rate for Payer: Cash Price |
$1,620.57
|
| Rate for Payer: Cash Price |
$1,620.57
|
| Rate for Payer: Cigna Commercial |
$537.59
|
| Rate for Payer: Healthspan PPO |
$517.41
|
| Rate for Payer: Humana Medicaid |
$362.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$464.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$302.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.33
|
| Rate for Payer: Molina Healthcare Passport |
$362.09
|
| Rate for Payer: Multiplan PHCS |
$1,944.68
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$393.52
|
| Rate for Payer: UHCCP Medicaid |
$266.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$365.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$302.71
|
|
|
PERC SKEL FIX HUM EPCNDYLR F(P
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 24566
|
| Hospital Charge Code |
761P0543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.26 |
| Max. Negotiated Rate |
$1,105.79 |
| Rate for Payer: Aetna Commercial |
$1,008.63
|
| Rate for Payer: Ambetter Exchange |
$689.12
|
| Rate for Payer: Anthem Medicaid |
$396.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$689.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$689.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$826.94
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,105.79
|
| Rate for Payer: Healthspan PPO |
$913.60
|
| Rate for Payer: Humana Medicaid |
$396.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$877.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$689.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$689.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$404.19
|
| Rate for Payer: Molina Healthcare Passport |
$396.26
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$895.86
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$400.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$689.12
|
|
|
PERC SKEL FIX HUM EPCNDYLR FX
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 24566
|
| Hospital Charge Code |
76100543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.50 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.25
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
PERC SKEL FIX HUM EPCNDYLR FX
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 24566
|
| Hospital Charge Code |
76100543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.26 |
| Max. Negotiated Rate |
$1,105.79 |
| Rate for Payer: Aetna Commercial |
$1,008.63
|
| Rate for Payer: Ambetter Exchange |
$689.12
|
| Rate for Payer: Anthem Medicaid |
$396.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$689.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$689.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$826.94
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,105.79
|
| Rate for Payer: Healthspan PPO |
$913.60
|
| Rate for Payer: Humana Medicaid |
$396.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$877.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$689.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$689.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$404.19
|
| Rate for Payer: Molina Healthcare Passport |
$396.26
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$895.86
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$400.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$689.12
|
|
|
PERC SKEL FIX HUM EPCNDYLR FX
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 24566
|
| Hospital Charge Code |
76100543
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$627.62 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem Medicaid |
$627.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Humana KY Medicaid |
$627.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$634.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.25
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
PERC TESTS (SCRATCHPUNCHPRICK)
|
Facility
|
IP
|
$1,302.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
761T2497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.60 |
| Max. Negotiated Rate |
$1,249.92 |
| Rate for Payer: Aetna Commercial |
$1,002.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,015.56
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna Commercial |
$1,080.66
|
| Rate for Payer: First Health Commercial |
$1,236.90
|
| Rate for Payer: Humana Commercial |
$1,106.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,067.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$960.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,145.76
|
| Rate for Payer: Ohio Health Group HMO |
$976.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,041.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$898.38
|
| Rate for Payer: PHCS Commercial |
$1,249.92
|
| Rate for Payer: United Healthcare All Payer |
$1,145.76
|
|
|
PERC TESTS (SCRATCHPUNCHPRICK)
|
Professional
|
Both
|
$1,312.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
76102497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$787.20 |
| Rate for Payer: Aetna Commercial |
$7.46
|
| Rate for Payer: Ambetter Exchange |
$3.31
|
| Rate for Payer: Anthem Medicaid |
$2.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.97
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cigna Commercial |
$8.07
|
| Rate for Payer: Healthspan PPO |
$10.05
|
| Rate for Payer: Humana Medicaid |
$2.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2.88
|
| Rate for Payer: Molina Healthcare Passport |
$2.82
|
| Rate for Payer: Multiplan PHCS |
$787.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4.30
|
| Rate for Payer: UHCCP Medicaid |
$459.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.31
|
|
|
PERC TESTS (SCRATCHPUNCHPRICK)
|
Facility
|
OP
|
$1,302.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
761T2497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.76 |
| Max. Negotiated Rate |
$1,316.07 |
| Rate for Payer: Aetna Commercial |
$1,002.54
|
| Rate for Payer: Anthem Medicaid |
$447.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$940.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,015.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,316.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,269.07
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cash Price |
$651.00
|
| Rate for Payer: Cigna Commercial |
$1,080.66
|
| Rate for Payer: First Health Commercial |
$1,236.90
|
| Rate for Payer: Humana Commercial |
$1,106.70
|
| Rate for Payer: Humana KY Medicaid |
$447.76
|
| Rate for Payer: Humana Medicare Advantage |
$940.05
|
| Rate for Payer: Kentucky WC Medicaid |
$452.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,067.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$960.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,145.76
|
| Rate for Payer: Ohio Health Group HMO |
$976.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,041.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$898.38
|
| Rate for Payer: PHCS Commercial |
$1,249.92
|
| Rate for Payer: United Healthcare All Payer |
$1,145.76
|
|
|
PERC TESTS (SCRATCHPUNCHPRICK)
|
Facility
|
OP
|
$1,312.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
76102497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,316.07 |
| Rate for Payer: Aetna Commercial |
$1,010.24
|
| Rate for Payer: Anthem Medicaid |
$451.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$940.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,023.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,316.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,269.07
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cigna Commercial |
$1,088.96
|
| Rate for Payer: First Health Commercial |
$1,246.40
|
| Rate for Payer: Humana Commercial |
$1,115.20
|
| Rate for Payer: Humana KY Medicaid |
$451.20
|
| Rate for Payer: Humana Medicare Advantage |
$940.05
|
| Rate for Payer: Kentucky WC Medicaid |
$455.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,075.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$968.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$460.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,154.56
|
| Rate for Payer: Ohio Health Group HMO |
$984.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,049.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$905.28
|
| Rate for Payer: PHCS Commercial |
$1,259.52
|
| Rate for Payer: United Healthcare All Payer |
$1,154.56
|
|
|
PERC TESTS (SCRATCHPUNCHPRICK)
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
761P2497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Aetna Commercial |
$7.46
|
| Rate for Payer: Ambetter Exchange |
$3.31
|
| Rate for Payer: Anthem Medicaid |
$2.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.97
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.07
|
| Rate for Payer: Healthspan PPO |
$10.05
|
| Rate for Payer: Humana Medicaid |
$2.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2.88
|
| Rate for Payer: Molina Healthcare Passport |
$2.82
|
| Rate for Payer: Multiplan PHCS |
$6.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4.30
|
| Rate for Payer: UHCCP Medicaid |
$3.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.31
|
|
