|
PERFORMER INTRO.SHEATH 12F
|
Facility
|
OP
|
$1,124.30
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.29 |
| Max. Negotiated Rate |
$1,079.33 |
| Rate for Payer: Aetna Commercial |
$865.71
|
| Rate for Payer: Anthem Medicaid |
$386.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$876.95
|
| Rate for Payer: Cash Price |
$562.15
|
| Rate for Payer: Cigna Commercial |
$933.17
|
| Rate for Payer: First Health Commercial |
$1,068.09
|
| Rate for Payer: Humana Commercial |
$955.65
|
| Rate for Payer: Humana KY Medicaid |
$386.65
|
| Rate for Payer: Kentucky WC Medicaid |
$390.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$921.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$829.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$989.38
|
| Rate for Payer: Ohio Health Group HMO |
$843.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.77
|
| Rate for Payer: PHCS Commercial |
$1,079.33
|
| Rate for Payer: United Healthcare All Payer |
$989.38
|
|
|
PERFORMER INTRO.SHEATH 12F
|
Facility
|
IP
|
$1,124.30
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.29 |
| Max. Negotiated Rate |
$1,079.33 |
| Rate for Payer: Aetna Commercial |
$865.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$876.95
|
| Rate for Payer: Cash Price |
$562.15
|
| Rate for Payer: Cigna Commercial |
$933.17
|
| Rate for Payer: First Health Commercial |
$1,068.09
|
| Rate for Payer: Humana Commercial |
$955.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$921.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$829.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$989.38
|
| Rate for Payer: Ohio Health Group HMO |
$843.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.77
|
| Rate for Payer: PHCS Commercial |
$1,079.33
|
| Rate for Payer: United Healthcare All Payer |
$989.38
|
|
|
PERFUSION LUNG SCAN
|
Facility
|
IP
|
$965.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
34000024
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$289.50 |
| Max. Negotiated Rate |
$926.40 |
| Rate for Payer: Aetna Commercial |
$743.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$752.70
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cigna Commercial |
$800.95
|
| Rate for Payer: First Health Commercial |
$916.75
|
| Rate for Payer: Humana Commercial |
$820.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$791.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$712.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$849.20
|
| Rate for Payer: Ohio Health Group HMO |
$723.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$839.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$665.85
|
| Rate for Payer: PHCS Commercial |
$926.40
|
| Rate for Payer: United Healthcare All Payer |
$849.20
|
|
|
PERFUSION LUNG SCAN
|
Professional
|
Both
|
$965.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
34000024
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$41.05 |
| Max. Negotiated Rate |
$579.00 |
| Rate for Payer: Aetna Commercial |
$311.36
|
| Rate for Payer: Ambetter Exchange |
$190.74
|
| Rate for Payer: Anthem Medicaid |
$124.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.89
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cigna Commercial |
$270.39
|
| Rate for Payer: Healthspan PPO |
$311.20
|
| Rate for Payer: Humana Medicaid |
$124.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$127.36
|
| Rate for Payer: Molina Healthcare Passport |
$124.86
|
| Rate for Payer: Multiplan PHCS |
$579.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.96
|
| Rate for Payer: UHCCP Medicaid |
$337.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$126.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.74
|
|
|
PERFUSION LUNG SCAN
|
Facility
|
OP
|
$965.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
34000024
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$331.86 |
| Max. Negotiated Rate |
$926.40 |
| Rate for Payer: Aetna Commercial |
$743.05
|
| Rate for Payer: Anthem Medicaid |
$331.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$752.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cigna Commercial |
$800.95
|
| Rate for Payer: First Health Commercial |
$916.75
|
| Rate for Payer: Humana Commercial |
$820.25
|
| Rate for Payer: Humana KY Medicaid |
$331.86
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$335.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$791.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$712.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$338.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$849.20
|
| Rate for Payer: Ohio Health Group HMO |
$723.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$839.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$665.85
|
| Rate for Payer: PHCS Commercial |
$926.40
|
| Rate for Payer: United Healthcare All Payer |
$849.20
|
|
|
PERFUSION LUNG SCAN(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
340P0024
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$41.05 |
| Max. Negotiated Rate |
$311.36 |
| Rate for Payer: Aetna Commercial |
$311.36
|
| Rate for Payer: Ambetter Exchange |
$190.74
|
| Rate for Payer: Anthem Medicaid |
$124.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.89
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$270.39
|
| Rate for Payer: Healthspan PPO |
$311.20
|
| Rate for Payer: Humana Medicaid |
$124.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$127.36
|
| Rate for Payer: Molina Healthcare Passport |
$124.86
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.96
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$126.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.74
|
|
|
PERFUSION LUNG SCAN(T
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
340T0024
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$244.50 |
| Max. Negotiated Rate |
$782.40 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.35
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
PERFUSION LUNG SCAN(T
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 78580
|
| Hospital Charge Code |
340T0024
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$280.28 |
| Max. Negotiated Rate |
$782.40 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem Medicaid |
$280.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Humana KY Medicaid |
$280.28
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$283.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.35
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
PERIACTIN (CYPROHEPTA 4MG/1TAB
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 50742019001
|
| Hospital Charge Code |
25001175
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
PERIACTIN (CYPROHEPTA 4MG/1TAB
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 50742019001
|
| Hospital Charge Code |
25001175
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
PERIACTIN SYRUP 5ML
|
Facility
|
IP
|
$4.74
|
|
|
Service Code
|
NDC 70752010112
|
| Hospital Charge Code |
25003350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cigna Commercial |
$3.93
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: Humana Commercial |
$4.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.17
|
| Rate for Payer: Ohio Health Group HMO |
$3.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.27
|
| Rate for Payer: PHCS Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Payer |
$4.17
|
|
|
PERIACTIN SYRUP 5ML
|
Facility
|
OP
|
$4.74
|
|
|
Service Code
|
NDC 70752010112
|
| Hospital Charge Code |
25003350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Anthem Medicaid |
$1.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cigna Commercial |
$3.93
|
| Rate for Payer: First Health Commercial |
$4.50
|
| Rate for Payer: Humana Commercial |
$4.03
|
| Rate for Payer: Humana KY Medicaid |
$1.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.17
|
| Rate for Payer: Ohio Health Group HMO |
$3.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.27
|
| Rate for Payer: PHCS Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Payer |
$4.17
|
|
|
PERICARDIAL FLUID CELL CNT
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001540
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem Medicaid |
$5.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Humana KY Medicaid |
$5.60
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
PERICARDIAL FLUID CELL CNT
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001540
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
PERICARDIOCENTESIS TRAY 8.3FR
|
Facility
|
IP
|
$1,993.96
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.19 |
| Max. Negotiated Rate |
$1,914.20 |
| Rate for Payer: Aetna Commercial |
$1,535.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,555.29
|
| Rate for Payer: Cash Price |
$996.98
|
| Rate for Payer: Cigna Commercial |
$1,654.99
|
| Rate for Payer: First Health Commercial |
$1,894.26
|
| Rate for Payer: Humana Commercial |
$1,694.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,635.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,471.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,754.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,495.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,595.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,734.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,375.83
|
| Rate for Payer: PHCS Commercial |
$1,914.20
|
| Rate for Payer: United Healthcare All Payer |
$1,754.68
|
|
|
PERICARDIOCENTESIS TRAY 8.3FR
|
Facility
|
OP
|
$1,993.96
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.19 |
| Max. Negotiated Rate |
$1,914.20 |
| Rate for Payer: Aetna Commercial |
$1,535.35
|
| Rate for Payer: Anthem Medicaid |
$685.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,555.29
|
| Rate for Payer: Cash Price |
$996.98
|
| Rate for Payer: Cigna Commercial |
$1,654.99
|
| Rate for Payer: First Health Commercial |
$1,894.26
|
| Rate for Payer: Humana Commercial |
$1,694.87
|
| Rate for Payer: Humana KY Medicaid |
$685.72
|
| Rate for Payer: Kentucky WC Medicaid |
$692.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,635.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,471.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$699.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,754.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,495.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,595.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,734.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,375.83
|
| Rate for Payer: PHCS Commercial |
$1,914.20
|
| Rate for Payer: United Healthcare All Payer |
$1,754.68
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$2,696.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$927.15 |
| Max. Negotiated Rate |
$2,588.16 |
| Rate for Payer: Aetna Commercial |
$2,075.92
|
| Rate for Payer: Anthem Medicaid |
$927.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,102.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cigna Commercial |
$2,237.68
|
| Rate for Payer: First Health Commercial |
$2,561.20
|
| Rate for Payer: Humana Commercial |
$2,291.60
|
| Rate for Payer: Humana KY Medicaid |
$927.15
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$936.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,210.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,989.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$945.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,372.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,022.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,345.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,860.24
|
| Rate for Payer: PHCS Commercial |
$2,588.16
|
| Rate for Payer: United Healthcare All Payer |
$2,372.48
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$2,696.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$808.80 |
| Max. Negotiated Rate |
$2,588.16 |
| Rate for Payer: Aetna Commercial |
$2,075.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,102.88
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cigna Commercial |
$2,237.68
|
| Rate for Payer: First Health Commercial |
$2,561.20
|
| Rate for Payer: Humana Commercial |
$2,291.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,210.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,989.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$808.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,372.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,022.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,345.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,860.24
|
| Rate for Payer: PHCS Commercial |
$2,588.16
|
| Rate for Payer: United Healthcare All Payer |
$2,372.48
|
|
|
PERICARDIOCENTESIS W/IMAGING
|
Professional
|
Both
|
$2,696.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$1,617.60 |
| Rate for Payer: Ambetter Exchange |
$219.53
|
| Rate for Payer: Anthem Medicaid |
$190.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$219.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$219.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$263.44
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Humana Medicaid |
$190.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$328.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$219.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$219.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.54
|
| Rate for Payer: Molina Healthcare Passport |
$190.73
|
| Rate for Payer: Multiplan PHCS |
$1,617.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$285.39
|
| Rate for Payer: UHCCP Medicaid |
$943.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$219.53
|
|
|
PERICARDIOCENTESIS W/IMAGI (P)
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
481P0099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$328.91 |
| Rate for Payer: Ambetter Exchange |
$219.53
|
| Rate for Payer: Anthem Medicaid |
$190.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$219.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$219.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$263.44
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Humana Medicaid |
$190.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$328.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$219.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$219.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.54
|
| Rate for Payer: Molina Healthcare Passport |
$190.73
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$285.39
|
| Rate for Payer: UHCCP Medicaid |
$91.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$219.53
|
|
|
PERICARDIOCENTESIS W/IMAGI (T)
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
481T0099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$730.80 |
| Max. Negotiated Rate |
$2,338.56 |
| Rate for Payer: Aetna Commercial |
$1,875.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,900.08
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$2,021.88
|
| Rate for Payer: First Health Commercial |
$2,314.20
|
| Rate for Payer: Humana Commercial |
$2,070.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,997.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,797.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,143.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,948.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,119.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,680.84
|
| Rate for Payer: PHCS Commercial |
$2,338.56
|
| Rate for Payer: United Healthcare All Payer |
$2,143.68
|
|
|
PERICARDIOCENTESIS W/IMAGI (T)
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 33016
|
| Hospital Charge Code |
481T0099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$837.74 |
| Max. Negotiated Rate |
$2,338.56 |
| Rate for Payer: Aetna Commercial |
$1,875.72
|
| Rate for Payer: Anthem Medicaid |
$837.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,900.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cash Price |
$1,218.00
|
| Rate for Payer: Cigna Commercial |
$2,021.88
|
| Rate for Payer: First Health Commercial |
$2,314.20
|
| Rate for Payer: Humana Commercial |
$2,070.60
|
| Rate for Payer: Humana KY Medicaid |
$837.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$846.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,997.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,797.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$854.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,143.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,948.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,119.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,680.84
|
| Rate for Payer: PHCS Commercial |
$2,338.56
|
| Rate for Payer: United Healthcare All Payer |
$2,143.68
|
|
|
PERICARD WINDOW/PARATIAL RESEC
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33025
|
| Hospital Charge Code |
761P1239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$726.09 |
| Max. Negotiated Rate |
$1,351.60 |
| Rate for Payer: Aetna Commercial |
$1,351.60
|
| Rate for Payer: Ambetter Exchange |
$726.09
|
| Rate for Payer: Anthem Medicaid |
$757.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$726.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$726.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$871.31
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,274.15
|
| Rate for Payer: Healthspan PPO |
$1,328.89
|
| Rate for Payer: Humana Medicaid |
$757.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,115.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$726.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$726.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$773.15
|
| Rate for Payer: Molina Healthcare Passport |
$757.99
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$943.92
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$765.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$726.09
|
|
|
PERICARD WINDOW/PARATIAL RESEC
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33025
|
| Hospital Charge Code |
76101239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
PERICARD WINDOW/PARATIAL RESEC
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33025
|
| Hospital Charge Code |
76101239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
