|
PERICARD WINDOW/PARATIAL RESEC
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33025
|
| Hospital Charge Code |
76101239
|
|
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
|
|
|
PERIDEX (CHLORHEXIDINE)EA15 ML
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
NDC 116200116
|
| Hospital Charge Code |
25001176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
PERIDEX (CHLORHEXIDINE)EA15 ML
|
Facility
|
IP
|
$4.36
|
|
|
Service Code
|
NDC 116200116
|
| Hospital Charge Code |
25001176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.62
|
| Rate for Payer: First Health Commercial |
$4.14
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.84
|
| Rate for Payer: Ohio Health Group HMO |
$3.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.01
|
| Rate for Payer: PHCS Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Payer |
$3.84
|
|
|
PERI-IMPLANT CAPSULECTOMY, BREAST, COMPLETE, INCLUDING REMOVAL OF ALL INTRACAPSULAR CONTENTS
|
Facility
|
OP
|
$4,953.45
|
|
|
Service Code
|
CPT 19371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,538.18 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
|
|
PER/INT FIX MEDIAL MALLEOUS FX
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27899
|
| Hospital Charge Code |
76103021
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$931.00 |
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$931.00
|
| Rate for Payer: UHCCP Medicaid |
$465.50
|
|
|
PERIPATCH BIOLOGIC 0.8*8 TAPER
|
Facility
|
OP
|
$2,246.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.86 |
| Max. Negotiated Rate |
$2,156.35 |
| Rate for Payer: Aetna Commercial |
$1,729.57
|
| Rate for Payer: Anthem Medicaid |
$772.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,752.04
|
| Rate for Payer: Cash Price |
$1,123.10
|
| Rate for Payer: Cigna Commercial |
$1,864.35
|
| Rate for Payer: First Health Commercial |
$2,133.89
|
| Rate for Payer: Humana Commercial |
$1,909.27
|
| Rate for Payer: Humana KY Medicaid |
$772.47
|
| Rate for Payer: Kentucky WC Medicaid |
$780.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,841.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,657.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$673.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$787.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,976.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,684.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,954.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,549.88
|
| Rate for Payer: PHCS Commercial |
$2,156.35
|
| Rate for Payer: United Healthcare All Payer |
$1,976.66
|
|
|
PERIPATCH BIOLOGIC 0.8*8 TAPER
|
Facility
|
IP
|
$2,246.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.86 |
| Max. Negotiated Rate |
$2,156.35 |
| Rate for Payer: Aetna Commercial |
$1,729.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,752.04
|
| Rate for Payer: Cash Price |
$1,123.10
|
| Rate for Payer: Cigna Commercial |
$1,864.35
|
| Rate for Payer: First Health Commercial |
$2,133.89
|
| Rate for Payer: Humana Commercial |
$1,909.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,841.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,657.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$673.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,976.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,684.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,954.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,549.88
|
| Rate for Payer: PHCS Commercial |
$2,156.35
|
| Rate for Payer: United Healthcare All Payer |
$1,976.66
|
|
|
PERIPROSTHETIC CAPSULECTOMY BR
|
Facility
|
OP
|
$5,868.00
|
|
|
Service Code
|
HCPCS 19371
|
| Hospital Charge Code |
761T0322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,018.01 |
| Max. Negotiated Rate |
$5,633.28 |
| Rate for Payer: Aetna Commercial |
$4,518.36
|
| Rate for Payer: Anthem Medicaid |
$2,018.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,577.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,934.00
|
| Rate for Payer: Cash Price |
$2,934.00
|
| Rate for Payer: Cigna Commercial |
$4,870.44
|
| Rate for Payer: First Health Commercial |
$5,574.60
|
| Rate for Payer: Humana Commercial |
$4,987.80
|
| Rate for Payer: Humana KY Medicaid |
$2,018.01
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,038.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,811.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,330.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,058.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,163.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,401.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,694.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,105.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,048.92
|
| Rate for Payer: PHCS Commercial |
$5,633.28
|
| Rate for Payer: United Healthcare All Payer |
$5,163.84
|
|
|
PERIPROSTHETIC CAPSULECTOMY BR
|
Facility
|
IP
|
$5,868.00
|
|
|
Service Code
|
HCPCS 19371
|
| Hospital Charge Code |
761T0322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,760.40 |
| Max. Negotiated Rate |
$5,633.28 |
| Rate for Payer: Aetna Commercial |
$4,518.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,577.04
|
| Rate for Payer: Cash Price |
$2,934.00
|
| Rate for Payer: Cigna Commercial |
$4,870.44
|
| Rate for Payer: First Health Commercial |
$5,574.60
|
| Rate for Payer: Humana Commercial |
$4,987.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,811.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,330.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,760.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,163.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,401.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,694.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,105.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,048.92
|
| Rate for Payer: PHCS Commercial |
$5,633.28
|
| Rate for Payer: United Healthcare All Payer |
$5,163.84
|
|
|
PERIPROSTHETIC CAPSULECTOMY BR
|
Facility
|
OP
|
$7,468.00
|
|
|
Service Code
|
HCPCS 19371
|
| Hospital Charge Code |
76100322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,568.25 |
| Max. Negotiated Rate |
$7,169.28 |
| Rate for Payer: Aetna Commercial |
$5,750.36
|
| Rate for Payer: Anthem Medicaid |
$2,568.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,825.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$3,734.00
|
| Rate for Payer: Cash Price |
$3,734.00
|
| Rate for Payer: Cigna Commercial |
$6,198.44
|
| Rate for Payer: First Health Commercial |
$7,094.60
|
| Rate for Payer: Humana Commercial |
$6,347.80
|
| Rate for Payer: Humana KY Medicaid |
$2,568.25
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,619.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,601.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,497.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.92
|
| Rate for Payer: PHCS Commercial |
$7,169.28
|
| Rate for Payer: United Healthcare All Payer |
$6,571.84
|
|
|
PERIPROSTHETIC CAPSULECTOMY BR
|
Facility
|
IP
|
$7,468.00
|
|
|
Service Code
|
HCPCS 19371
|
| Hospital Charge Code |
76100322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,240.40 |
| Max. Negotiated Rate |
$7,169.28 |
| Rate for Payer: Aetna Commercial |
$5,750.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,825.04
|
| Rate for Payer: Cash Price |
$3,734.00
|
| Rate for Payer: Cigna Commercial |
$6,198.44
|
| Rate for Payer: First Health Commercial |
$7,094.60
|
| Rate for Payer: Humana Commercial |
$6,347.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,601.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,497.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.92
|
| Rate for Payer: PHCS Commercial |
$7,169.28
|
| Rate for Payer: United Healthcare All Payer |
$6,571.84
|
|
|
PERIPROSTHETIC CAPSULECTOMY BR
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 19371
|
| Hospital Charge Code |
761P0322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.98 |
| Max. Negotiated Rate |
$1,135.38 |
| Rate for Payer: Aetna Commercial |
$1,135.38
|
| Rate for Payer: Ambetter Exchange |
$675.30
|
| Rate for Payer: Anthem Medicaid |
$508.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$675.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$810.36
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,077.89
|
| Rate for Payer: Healthspan PPO |
$907.84
|
| Rate for Payer: Humana Medicaid |
$508.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,007.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$675.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$519.16
|
| Rate for Payer: Molina Healthcare Passport |
$508.98
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$877.89
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$514.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$675.30
|
|
|
PERIPROSTHETIC CAPSULECTOMY BR
|
Professional
|
Both
|
$7,468.00
|
|
|
Service Code
|
HCPCS 19371
|
| Hospital Charge Code |
76100322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.98 |
| Max. Negotiated Rate |
$4,480.80 |
| Rate for Payer: Aetna Commercial |
$1,135.38
|
| Rate for Payer: Ambetter Exchange |
$675.30
|
| Rate for Payer: Anthem Medicaid |
$508.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$675.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$810.36
|
| Rate for Payer: Cash Price |
$3,734.00
|
| Rate for Payer: Cash Price |
$3,734.00
|
| Rate for Payer: Cigna Commercial |
$1,077.89
|
| Rate for Payer: Healthspan PPO |
$907.84
|
| Rate for Payer: Humana Medicaid |
$508.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,007.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$675.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$519.16
|
| Rate for Payer: Molina Healthcare Passport |
$508.98
|
| Rate for Payer: Multiplan PHCS |
$4,480.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$877.89
|
| Rate for Payer: UHCCP Medicaid |
$2,613.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$514.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$675.30
|
|
|
PERITONEAL FLUID CELL CNT
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001537
|
|
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
|
|
|
PERITONEAL FLUID CELL CNT
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001537
|
|
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
|
|
|
PERITONEAL-VEN.SHUNT TEST
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
HCPCS 78291
|
| Hospital Charge Code |
34000076
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,575.36 |
| Rate for Payer: Aetna Commercial |
$1,263.57
|
| Rate for Payer: Anthem Medicaid |
$564.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$820.50
|
| Rate for Payer: Cash Price |
$820.50
|
| Rate for Payer: Cigna Commercial |
$1,362.03
|
| Rate for Payer: First Health Commercial |
$1,558.95
|
| Rate for Payer: Humana Commercial |
$1,394.85
|
| Rate for Payer: Humana KY Medicaid |
$564.34
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$570.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,345.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,211.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$575.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,444.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,427.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,132.29
|
| Rate for Payer: PHCS Commercial |
$1,575.36
|
| Rate for Payer: United Healthcare All Payer |
$1,444.08
|
|
|
PERITONEAL-VEN.SHUNT TEST
|
Professional
|
Both
|
$1,641.00
|
|
|
Service Code
|
HCPCS 78291
|
| Hospital Charge Code |
34000076
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$49.25 |
| Max. Negotiated Rate |
$984.60 |
| Rate for Payer: Aetna Commercial |
$357.80
|
| Rate for Payer: Ambetter Exchange |
$213.25
|
| Rate for Payer: Anthem Medicaid |
$120.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$213.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$213.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$255.90
|
| Rate for Payer: Cash Price |
$820.50
|
| Rate for Payer: Cash Price |
$820.50
|
| Rate for Payer: Cigna Commercial |
$277.46
|
| Rate for Payer: Healthspan PPO |
$357.62
|
| Rate for Payer: Humana Medicaid |
$120.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$49.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$213.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.84
|
| Rate for Payer: Molina Healthcare Passport |
$120.43
|
| Rate for Payer: Multiplan PHCS |
$984.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$277.23
|
| Rate for Payer: UHCCP Medicaid |
$574.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$213.25
|
|
|
PERITONEAL-VEN.SHUNT TEST
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
HCPCS 78291
|
| Hospital Charge Code |
34000076
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$492.30 |
| Max. Negotiated Rate |
$1,575.36 |
| Rate for Payer: Aetna Commercial |
$1,263.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.98
|
| Rate for Payer: Cash Price |
$820.50
|
| Rate for Payer: Cigna Commercial |
$1,362.03
|
| Rate for Payer: First Health Commercial |
$1,558.95
|
| Rate for Payer: Humana Commercial |
$1,394.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,345.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,211.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,444.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,427.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,132.29
|
| Rate for Payer: PHCS Commercial |
$1,575.36
|
| Rate for Payer: United Healthcare All Payer |
$1,444.08
|
|
|
PERITONEAL-VEN.SHUNT TEST(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 78291
|
| Hospital Charge Code |
340P0076
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$49.25 |
| Max. Negotiated Rate |
$357.80 |
| Rate for Payer: Aetna Commercial |
$357.80
|
| Rate for Payer: Ambetter Exchange |
$213.25
|
| Rate for Payer: Anthem Medicaid |
$120.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$213.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$213.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$255.90
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$277.46
|
| Rate for Payer: Healthspan PPO |
$357.62
|
| Rate for Payer: Humana Medicaid |
$120.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$49.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$213.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.84
|
| Rate for Payer: Molina Healthcare Passport |
$120.43
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$277.23
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$213.25
|
|
|
PERITONEAL-VEN.SHUNT TEST(T
|
Facility
|
IP
|
$1,291.00
|
|
|
Service Code
|
HCPCS 78291
|
| Hospital Charge Code |
340T0076
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$387.30 |
| Max. Negotiated Rate |
$1,239.36 |
| Rate for Payer: Aetna Commercial |
$994.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.98
|
| Rate for Payer: Cash Price |
$645.50
|
| Rate for Payer: Cigna Commercial |
$1,071.53
|
| Rate for Payer: First Health Commercial |
$1,226.45
|
| Rate for Payer: Humana Commercial |
$1,097.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,058.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,136.08
|
| Rate for Payer: Ohio Health Group HMO |
$968.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$890.79
|
| Rate for Payer: PHCS Commercial |
$1,239.36
|
| Rate for Payer: United Healthcare All Payer |
$1,136.08
|
|
|
PERITONEAL-VEN.SHUNT TEST(T
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
HCPCS 78291
|
| Hospital Charge Code |
340T0076
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,239.36 |
| Rate for Payer: Aetna Commercial |
$994.07
|
| Rate for Payer: Anthem Medicaid |
$443.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$645.50
|
| Rate for Payer: Cash Price |
$645.50
|
| Rate for Payer: Cigna Commercial |
$1,071.53
|
| Rate for Payer: First Health Commercial |
$1,226.45
|
| Rate for Payer: Humana Commercial |
$1,097.35
|
| Rate for Payer: Humana KY Medicaid |
$443.97
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$448.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,058.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$452.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,136.08
|
| Rate for Payer: Ohio Health Group HMO |
$968.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$890.79
|
| Rate for Payer: PHCS Commercial |
$1,239.36
|
| Rate for Payer: United Healthcare All Payer |
$1,136.08
|
|
|
PERMANENT NAIL REMOVAL
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.70 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
PERMANENT NAIL REMOVAL
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
76100099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.41 |
| Max. Negotiated Rate |
$824.64 |
| Rate for Payer: Aetna Commercial |
$661.43
|
| Rate for Payer: Anthem Medicaid |
$295.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$429.50
|
| Rate for Payer: Cash Price |
$429.50
|
| Rate for Payer: Cigna Commercial |
$712.97
|
| Rate for Payer: First Health Commercial |
$816.05
|
| Rate for Payer: Humana Commercial |
$730.15
|
| Rate for Payer: Humana KY Medicaid |
$295.41
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$298.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$704.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$633.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$301.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$755.92
|
| Rate for Payer: Ohio Health Group HMO |
$644.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$747.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.71
|
| Rate for Payer: PHCS Commercial |
$824.64
|
| Rate for Payer: United Healthcare All Payer |
$755.92
|
|
|
PERMANENT NAIL REMOVAL
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
76100099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.81 |
| Max. Negotiated Rate |
$515.40 |
| Rate for Payer: Aetna Commercial |
$251.62
|
| Rate for Payer: Ambetter Exchange |
$95.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.81
|
| Rate for Payer: Anthem Medicaid |
$109.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$95.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.64
|
| Rate for Payer: Cash Price |
$429.50
|
| Rate for Payer: Cash Price |
$429.50
|
| Rate for Payer: Cigna Commercial |
$270.66
|
| Rate for Payer: Healthspan PPO |
$238.86
|
| Rate for Payer: Humana Medicaid |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$95.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$111.84
|
| Rate for Payer: Molina Healthcare Passport |
$109.65
|
| Rate for Payer: Multiplan PHCS |
$515.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$124.19
|
| Rate for Payer: UHCCP Medicaid |
$75.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$110.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$95.53
|
|
|
PERMANENT NAIL REMOVAL
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
76100099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.70 |
| Max. Negotiated Rate |
$824.64 |
| Rate for Payer: Aetna Commercial |
$661.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.02
|
| Rate for Payer: Cash Price |
$429.50
|
| Rate for Payer: Cigna Commercial |
$712.97
|
| Rate for Payer: First Health Commercial |
$816.05
|
| Rate for Payer: Humana Commercial |
$730.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$704.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$633.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$755.92
|
| Rate for Payer: Ohio Health Group HMO |
$644.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$747.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.71
|
| Rate for Payer: PHCS Commercial |
$824.64
|
| Rate for Payer: United Healthcare All Payer |
$755.92
|
|
