|
PERQ PLMT BILE DUCT STENT
|
Facility
|
IP
|
$11,188.00
|
|
|
Service Code
|
HCPCS 47540
|
| Hospital Charge Code |
76101963
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,356.40 |
| Max. Negotiated Rate |
$10,740.48 |
| Rate for Payer: Aetna Commercial |
$8,614.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,726.64
|
| Rate for Payer: Cash Price |
$5,594.00
|
| Rate for Payer: Cigna Commercial |
$9,286.04
|
| Rate for Payer: First Health Commercial |
$10,628.60
|
| Rate for Payer: Humana Commercial |
$9,509.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,174.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,256.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,845.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,950.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,733.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,719.72
|
| Rate for Payer: PHCS Commercial |
$10,740.48
|
| Rate for Payer: United Healthcare All Payer |
$9,845.44
|
|
|
PERQ PLMT BILE DUCT STENT
|
Facility
|
OP
|
$11,188.00
|
|
|
Service Code
|
HCPCS 47540
|
| Hospital Charge Code |
76101963
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,847.55 |
| Max. Negotiated Rate |
$10,740.48 |
| Rate for Payer: Aetna Commercial |
$8,614.76
|
| Rate for Payer: Anthem Medicaid |
$3,847.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,726.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$5,594.00
|
| Rate for Payer: Cash Price |
$5,594.00
|
| Rate for Payer: Cigna Commercial |
$9,286.04
|
| Rate for Payer: First Health Commercial |
$10,628.60
|
| Rate for Payer: Humana Commercial |
$9,509.80
|
| Rate for Payer: Humana KY Medicaid |
$3,847.55
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,886.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,174.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,256.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,924.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,845.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,391.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,950.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,733.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,719.72
|
| Rate for Payer: PHCS Commercial |
$10,740.48
|
| Rate for Payer: United Healthcare All Payer |
$9,845.44
|
|
|
PERQ PLMT BILE DUCT STENT
|
Facility
|
OP
|
$4,210.00
|
|
|
Service Code
|
HCPCS 47539
|
| Hospital Charge Code |
76101962
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,447.82 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$3,241.70
|
| Rate for Payer: Anthem Medicaid |
$1,447.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,283.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$2,105.00
|
| Rate for Payer: Cash Price |
$2,105.00
|
| Rate for Payer: Cigna Commercial |
$3,494.30
|
| Rate for Payer: First Health Commercial |
$3,999.50
|
| Rate for Payer: Humana Commercial |
$3,578.50
|
| Rate for Payer: Humana KY Medicaid |
$1,447.82
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,462.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,452.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,106.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,476.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,704.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,904.90
|
| Rate for Payer: PHCS Commercial |
$4,041.60
|
| Rate for Payer: United Healthcare All Payer |
$3,704.80
|
|
|
PERQ PLMT BILE DUCT STENT (P
|
Professional
|
Both
|
$4,210.00
|
|
|
Service Code
|
HCPCS 47539
|
| Hospital Charge Code |
761P1962
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.03 |
| Max. Negotiated Rate |
$3,712.51 |
| Rate for Payer: Ambetter Exchange |
$393.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$362.03
|
| Rate for Payer: Anthem Medicaid |
$3,639.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$393.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$393.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$472.01
|
| Rate for Payer: Cash Price |
$2,105.00
|
| Rate for Payer: Cash Price |
$2,105.00
|
| Rate for Payer: Cigna Commercial |
$746.15
|
| Rate for Payer: Humana Medicaid |
$3,639.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$629.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$393.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,712.51
|
| Rate for Payer: Molina Healthcare Passport |
$3,639.72
|
| Rate for Payer: Multiplan PHCS |
$2,526.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$511.34
|
| Rate for Payer: UHCCP Medicaid |
$380.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,676.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$393.34
|
|
|
PERQ STENT/CHEST VERT ART
|
Professional
|
Both
|
$666.40
|
|
|
Service Code
|
HCPCS 0075T
|
| Hospital Charge Code |
76102655
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.24 |
| Max. Negotiated Rate |
$466.48 |
| Rate for Payer: Cash Price |
$333.20
|
| Rate for Payer: Multiplan PHCS |
$399.84
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$466.48
|
| Rate for Payer: UHCCP Medicaid |
$233.24
|
|
|
PERQ TRLUML CORONRY LITHOTRP
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 92972
|
| Hospital Charge Code |
76102809
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem Medicaid |
$106.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Humana KY Medicaid |
$106.27
|
| Rate for Payer: Kentucky WC Medicaid |
$107.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.21
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
PERQ TRLUML CORONRY LITHOTRP
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 92972
|
| Hospital Charge Code |
76102809
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.15 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Ambetter Exchange |
$136.66
|
| Rate for Payer: Anthem Medicaid |
$122.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Humana Medicaid |
$122.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$136.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$124.92
|
| Rate for Payer: Molina Healthcare Passport |
$122.47
|
| Rate for Payer: Multiplan PHCS |
$185.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$177.66
|
| Rate for Payer: UHCCP Medicaid |
$108.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.66
|
|
|
PERQ TRLUML CORONRY LITHOTRP
|
Professional
|
Both
|
$11,700.00
|
|
|
Service Code
|
HCPCS 92972
|
| Hospital Charge Code |
48100102
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$122.47 |
| Max. Negotiated Rate |
$7,020.00 |
| Rate for Payer: Ambetter Exchange |
$136.66
|
| Rate for Payer: Anthem Medicaid |
$122.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$5,850.00
|
| Rate for Payer: Cash Price |
$5,850.00
|
| Rate for Payer: Humana Medicaid |
$122.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$136.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$124.92
|
| Rate for Payer: Molina Healthcare Passport |
$122.47
|
| Rate for Payer: Multiplan PHCS |
$7,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$177.66
|
| Rate for Payer: UHCCP Medicaid |
$4,095.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.66
|
|
|
PERQ TRLUML CORONRY LITHOTRP
|
Facility
|
OP
|
$11,700.00
|
|
|
Service Code
|
HCPCS 92972
|
| Hospital Charge Code |
48100102
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,510.00 |
| Max. Negotiated Rate |
$11,232.00 |
| Rate for Payer: Aetna Commercial |
$9,009.00
|
| Rate for Payer: Anthem Medicaid |
$4,023.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,126.00
|
| Rate for Payer: Cash Price |
$5,850.00
|
| Rate for Payer: Cigna Commercial |
$9,711.00
|
| Rate for Payer: First Health Commercial |
$11,115.00
|
| Rate for Payer: Humana Commercial |
$9,945.00
|
| Rate for Payer: Humana KY Medicaid |
$4,023.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,064.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,594.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,634.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,104.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,296.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,775.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,179.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,073.00
|
| Rate for Payer: PHCS Commercial |
$11,232.00
|
| Rate for Payer: United Healthcare All Payer |
$10,296.00
|
|
|
PERQ TRLUML CORONRY LITHOTRP
|
Facility
|
IP
|
$11,700.00
|
|
|
Service Code
|
HCPCS 92972
|
| Hospital Charge Code |
48100102
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,510.00 |
| Max. Negotiated Rate |
$11,232.00 |
| Rate for Payer: Aetna Commercial |
$9,009.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,126.00
|
| Rate for Payer: Cash Price |
$5,850.00
|
| Rate for Payer: Cigna Commercial |
$9,711.00
|
| Rate for Payer: First Health Commercial |
$11,115.00
|
| Rate for Payer: Humana Commercial |
$9,945.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,594.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,634.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,296.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,775.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,179.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,073.00
|
| Rate for Payer: PHCS Commercial |
$11,232.00
|
| Rate for Payer: United Healthcare All Payer |
$10,296.00
|
|
|
PERQ TRLUML CORONRY LITHOTRP
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 92972
|
| Hospital Charge Code |
76102809
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.21
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
PERSANTINE (DIPYRIDA 25MG/1TAB
|
Facility
|
OP
|
$9.18
|
|
|
Service Code
|
NDC 64980013301
|
| Hospital Charge Code |
25001178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Anthem Medicaid |
$3.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.16
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna Commercial |
$7.62
|
| Rate for Payer: First Health Commercial |
$8.72
|
| Rate for Payer: Humana Commercial |
$7.80
|
| Rate for Payer: Humana KY Medicaid |
$3.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.08
|
| Rate for Payer: Ohio Health Group HMO |
$6.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.33
|
| Rate for Payer: PHCS Commercial |
$8.81
|
| Rate for Payer: United Healthcare All Payer |
$8.08
|
|
|
PERSANTINE (DIPYRIDA 25MG/1TAB
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
NDC 64980013301
|
| Hospital Charge Code |
25001178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.16
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna Commercial |
$7.62
|
| Rate for Payer: First Health Commercial |
$8.72
|
| Rate for Payer: Humana Commercial |
$7.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.08
|
| Rate for Payer: Ohio Health Group HMO |
$6.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.33
|
| Rate for Payer: PHCS Commercial |
$8.81
|
| Rate for Payer: United Healthcare All Payer |
$8.08
|
|
|
PERSERIS 0.5mg (120mg Kit)
|
Facility
|
IP
|
$15,798.68
|
|
|
Service Code
|
HCPCS J2798
|
| Hospital Charge Code |
25004327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,739.60 |
| Max. Negotiated Rate |
$15,166.73 |
| Rate for Payer: Aetna Commercial |
$12,164.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,322.97
|
| Rate for Payer: Cash Price |
$7,899.34
|
| Rate for Payer: Cigna Commercial |
$13,112.90
|
| Rate for Payer: First Health Commercial |
$15,008.75
|
| Rate for Payer: Humana Commercial |
$13,428.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,954.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,659.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,902.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,849.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,638.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,744.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,901.09
|
| Rate for Payer: PHCS Commercial |
$15,166.73
|
| Rate for Payer: United Healthcare All Payer |
$13,902.84
|
|
|
PERSERIS 0.5mg (120mg Kit)
|
Facility
|
OP
|
$15,798.68
|
|
|
Service Code
|
HCPCS J2798
|
| Hospital Charge Code |
25004327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.14 |
| Max. Negotiated Rate |
$15,166.73 |
| Rate for Payer: Aetna Commercial |
$12,164.98
|
| Rate for Payer: Anthem Medicaid |
$5,433.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,322.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.39
|
| Rate for Payer: Cash Price |
$7,899.34
|
| Rate for Payer: Cash Price |
$7,899.34
|
| Rate for Payer: Cigna Commercial |
$13,112.90
|
| Rate for Payer: First Health Commercial |
$15,008.75
|
| Rate for Payer: Humana Commercial |
$13,428.88
|
| Rate for Payer: Humana KY Medicaid |
$5,433.17
|
| Rate for Payer: Humana Medicare Advantage |
$12.14
|
| Rate for Payer: Kentucky WC Medicaid |
$5,488.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,954.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,659.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,542.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,902.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,849.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,638.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,744.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,901.09
|
| Rate for Payer: PHCS Commercial |
$15,166.73
|
| Rate for Payer: United Healthcare All Payer |
$13,902.84
|
|
|
PERSERIS 0.5mg (90mg Kit)
|
Facility
|
IP
|
$11,848.90
|
|
|
Service Code
|
HCPCS J2798
|
| Hospital Charge Code |
25004326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,554.67 |
| Max. Negotiated Rate |
$11,374.94 |
| Rate for Payer: Aetna Commercial |
$9,123.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,242.14
|
| Rate for Payer: Cash Price |
$5,924.45
|
| Rate for Payer: Cigna Commercial |
$9,834.59
|
| Rate for Payer: First Health Commercial |
$11,256.45
|
| Rate for Payer: Humana Commercial |
$10,071.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,716.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,744.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,554.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,427.03
|
| Rate for Payer: Ohio Health Group HMO |
$8,886.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,479.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,308.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,175.74
|
| Rate for Payer: PHCS Commercial |
$11,374.94
|
| Rate for Payer: United Healthcare All Payer |
$10,427.03
|
|
|
PERSERIS 0.5mg (90mg Kit)
|
Facility
|
OP
|
$11,848.90
|
|
|
Service Code
|
HCPCS J2798
|
| Hospital Charge Code |
25004326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.14 |
| Max. Negotiated Rate |
$11,374.94 |
| Rate for Payer: Aetna Commercial |
$9,123.65
|
| Rate for Payer: Anthem Medicaid |
$4,074.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,242.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.39
|
| Rate for Payer: Cash Price |
$5,924.45
|
| Rate for Payer: Cash Price |
$5,924.45
|
| Rate for Payer: Cigna Commercial |
$9,834.59
|
| Rate for Payer: First Health Commercial |
$11,256.45
|
| Rate for Payer: Humana Commercial |
$10,071.57
|
| Rate for Payer: Humana KY Medicaid |
$4,074.84
|
| Rate for Payer: Humana Medicare Advantage |
$12.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,116.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,716.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,744.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,156.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,427.03
|
| Rate for Payer: Ohio Health Group HMO |
$8,886.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,479.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,308.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,175.74
|
| Rate for Payer: PHCS Commercial |
$11,374.94
|
| Rate for Payer: United Healthcare All Payer |
$10,427.03
|
|
|
PERTUSSIS DETECT AGENT EACH
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001400
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$236.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$244.85
|
| Rate for Payer: First Health Commercial |
$280.25
|
| Rate for Payer: Humana Commercial |
$250.75
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.60
|
| Rate for Payer: Ohio Health Group HMO |
$221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$203.55
|
| Rate for Payer: PHCS Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Payer |
$259.60
|
|
|
PERTUSSIS DETECT AGENT EACH
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001400
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$88.50 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: Aetna Commercial |
$227.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$236.88
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$244.85
|
| Rate for Payer: First Health Commercial |
$280.25
|
| Rate for Payer: Humana Commercial |
$250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.60
|
| Rate for Payer: Ohio Health Group HMO |
$221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$236.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$203.55
|
| Rate for Payer: PHCS Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Payer |
$259.60
|
|
|
PERTUZUMAB 1 MG (420MG/14ML)
|
Facility
|
IP
|
$37,171.67
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
25002673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,151.50 |
| Max. Negotiated Rate |
$35,684.80 |
| Rate for Payer: Aetna Commercial |
$28,622.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,993.90
|
| Rate for Payer: Cash Price |
$18,585.83
|
| Rate for Payer: Cigna Commercial |
$30,852.49
|
| Rate for Payer: First Health Commercial |
$35,313.09
|
| Rate for Payer: Humana Commercial |
$31,595.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,480.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,432.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,151.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,711.07
|
| Rate for Payer: Ohio Health Group HMO |
$27,878.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,737.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,339.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,648.45
|
| Rate for Payer: PHCS Commercial |
$35,684.80
|
| Rate for Payer: United Healthcare All Payer |
$32,711.07
|
|
|
PERTUZUMAB 1 MG (420MG/14ML)
|
Facility
|
OP
|
$37,171.67
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
25002673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$35,684.80 |
| Rate for Payer: Aetna Commercial |
$28,622.19
|
| Rate for Payer: Anthem Medicaid |
$12,783.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,993.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.80
|
| Rate for Payer: Cash Price |
$18,585.83
|
| Rate for Payer: Cash Price |
$18,585.83
|
| Rate for Payer: Cigna Commercial |
$30,852.49
|
| Rate for Payer: First Health Commercial |
$35,313.09
|
| Rate for Payer: Humana Commercial |
$31,595.92
|
| Rate for Payer: Humana KY Medicaid |
$12,783.34
|
| Rate for Payer: Humana Medicare Advantage |
$16.89
|
| Rate for Payer: Kentucky WC Medicaid |
$12,913.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,480.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,432.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,039.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,711.07
|
| Rate for Payer: Ohio Health Group HMO |
$27,878.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,737.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,339.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,648.45
|
| Rate for Payer: PHCS Commercial |
$35,684.80
|
| Rate for Payer: United Healthcare All Payer |
$32,711.07
|
|
|
PET AQMBF PET REST & RX STRESS
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
HCPCS 78434
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,353.60 |
| Max. Negotiated Rate |
$4,331.52 |
| Rate for Payer: Aetna Commercial |
$3,474.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,519.36
|
| Rate for Payer: Cash Price |
$2,256.00
|
| Rate for Payer: Cigna Commercial |
$3,744.96
|
| Rate for Payer: First Health Commercial |
$4,286.40
|
| Rate for Payer: Humana Commercial |
$3,835.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,699.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,329.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,353.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,970.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,609.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,925.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,113.28
|
| Rate for Payer: PHCS Commercial |
$4,331.52
|
| Rate for Payer: United Healthcare All Payer |
$3,970.56
|
|
|
PET AQMBF PET REST & RX STRESS
|
Professional
|
Both
|
$4,512.00
|
|
|
Service Code
|
HCPCS 78434
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$35.27 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Cash Price |
$2,256.00
|
| Rate for Payer: Cash Price |
$2,256.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.27
|
| Rate for Payer: Multiplan PHCS |
$2,707.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,158.40
|
| Rate for Payer: UHCCP Medicaid |
$1,579.20
|
|
|
PET AQMBF PET REST & RX STRESS
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
HCPCS 78434
|
| Hospital Charge Code |
40400005
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$1,353.60 |
| Max. Negotiated Rate |
$4,331.52 |
| Rate for Payer: Aetna Commercial |
$3,474.24
|
| Rate for Payer: Anthem Medicaid |
$1,551.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,519.36
|
| Rate for Payer: Cash Price |
$2,256.00
|
| Rate for Payer: Cigna Commercial |
$3,744.96
|
| Rate for Payer: First Health Commercial |
$4,286.40
|
| Rate for Payer: Humana Commercial |
$3,835.20
|
| Rate for Payer: Humana KY Medicaid |
$1,551.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,567.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,699.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,329.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,353.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,582.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,970.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,384.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,609.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,925.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,113.28
|
| Rate for Payer: PHCS Commercial |
$4,331.52
|
| Rate for Payer: United Healthcare All Payer |
$3,970.56
|
|
|
PET CT FULLBODY
|
Professional
|
Both
|
$7,607.00
|
|
|
Service Code
|
HCPCS 78816
|
| Hospital Charge Code |
40400009
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$143.09 |
| Max. Negotiated Rate |
$5,324.90 |
| Rate for Payer: Aetna Commercial |
$2,081.06
|
| Rate for Payer: Anthem Medicaid |
$1,046.34
|
| Rate for Payer: Cash Price |
$3,803.50
|
| Rate for Payer: Cash Price |
$3,803.50
|
| Rate for Payer: Cigna Commercial |
$754.72
|
| Rate for Payer: Healthspan PPO |
$1,126.35
|
| Rate for Payer: Humana Medicaid |
$1,046.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,067.27
|
| Rate for Payer: Molina Healthcare Passport |
$1,046.34
|
| Rate for Payer: Multiplan PHCS |
$4,564.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,324.90
|
| Rate for Payer: UHCCP Medicaid |
$2,662.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,056.80
|
|
