|
PHYS REVIEW OF CVP MONITORING
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 93790
|
| Hospital Charge Code |
48000101
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$39.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$39.55
|
| Rate for Payer: Kentucky WC Medicaid |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
PHYS REVIEW OF CVP MONITORING
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 93790
|
| Hospital Charge Code |
48000101
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
PICC 4.5 FR SINGLE W/STYLETT
|
Facility
|
OP
|
$3,175.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$952.50 |
| Max. Negotiated Rate |
$3,048.00 |
| Rate for Payer: Aetna Commercial |
$2,444.75
|
| Rate for Payer: Anthem Medicaid |
$1,091.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,476.50
|
| Rate for Payer: Cash Price |
$1,587.50
|
| Rate for Payer: Cigna Commercial |
$2,635.25
|
| Rate for Payer: First Health Commercial |
$3,016.25
|
| Rate for Payer: Humana Commercial |
$2,698.75
|
| Rate for Payer: Humana KY Medicaid |
$1,091.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,102.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,603.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,343.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$952.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,113.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,794.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,381.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,762.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,190.75
|
| Rate for Payer: PHCS Commercial |
$3,048.00
|
| Rate for Payer: United Healthcare All Payer |
$2,794.00
|
|
|
PICC 4.5 FR SINGLE W/STYLETT
|
Facility
|
IP
|
$3,175.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$952.50 |
| Max. Negotiated Rate |
$3,048.00 |
| Rate for Payer: Aetna Commercial |
$2,444.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,476.50
|
| Rate for Payer: Cash Price |
$1,587.50
|
| Rate for Payer: Cigna Commercial |
$2,635.25
|
| Rate for Payer: First Health Commercial |
$3,016.25
|
| Rate for Payer: Humana Commercial |
$2,698.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,603.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,343.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$952.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,794.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,381.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,762.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,190.75
|
| Rate for Payer: PHCS Commercial |
$3,048.00
|
| Rate for Payer: United Healthcare All Payer |
$2,794.00
|
|
|
PIGTAIL 110CM
|
Facility
|
OP
|
$509.45
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.84 |
| Max. Negotiated Rate |
$489.07 |
| Rate for Payer: Aetna Commercial |
$392.28
|
| Rate for Payer: Anthem Medicaid |
$175.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.37
|
| Rate for Payer: Cash Price |
$254.72
|
| Rate for Payer: Cigna Commercial |
$422.84
|
| Rate for Payer: First Health Commercial |
$483.98
|
| Rate for Payer: Humana Commercial |
$433.03
|
| Rate for Payer: Humana KY Medicaid |
$175.20
|
| Rate for Payer: Kentucky WC Medicaid |
$176.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.32
|
| Rate for Payer: Ohio Health Group HMO |
$382.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.52
|
| Rate for Payer: PHCS Commercial |
$489.07
|
| Rate for Payer: United Healthcare All Payer |
$448.32
|
|
|
PIGTAIL 110CM
|
Facility
|
IP
|
$509.45
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.84 |
| Max. Negotiated Rate |
$489.07 |
| Rate for Payer: Aetna Commercial |
$392.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.37
|
| Rate for Payer: Cash Price |
$254.72
|
| Rate for Payer: Cigna Commercial |
$422.84
|
| Rate for Payer: First Health Commercial |
$483.98
|
| Rate for Payer: Humana Commercial |
$433.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.32
|
| Rate for Payer: Ohio Health Group HMO |
$382.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.52
|
| Rate for Payer: PHCS Commercial |
$489.07
|
| Rate for Payer: United Healthcare All Payer |
$448.32
|
|
|
PIGTAIL 145 CATH 5F
|
Facility
|
IP
|
$440.10
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.03 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$338.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.28
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna Commercial |
$365.28
|
| Rate for Payer: First Health Commercial |
$418.10
|
| Rate for Payer: Humana Commercial |
$374.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.29
|
| Rate for Payer: Ohio Health Group HMO |
$330.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.67
|
| Rate for Payer: PHCS Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Payer |
$387.29
|
|
|
PIGTAIL 145 CATH 5F
|
Facility
|
OP
|
$440.10
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.03 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$338.88
|
| Rate for Payer: Anthem Medicaid |
$151.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.28
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna Commercial |
$365.28
|
| Rate for Payer: First Health Commercial |
$418.10
|
| Rate for Payer: Humana Commercial |
$374.08
|
| Rate for Payer: Humana KY Medicaid |
$151.35
|
| Rate for Payer: Kentucky WC Medicaid |
$152.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.29
|
| Rate for Payer: Ohio Health Group HMO |
$330.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.67
|
| Rate for Payer: PHCS Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Payer |
$387.29
|
|
|
PIGTAIL 5FR 65CM
|
Facility
|
OP
|
$512.15
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.65 |
| Max. Negotiated Rate |
$491.66 |
| Rate for Payer: Aetna Commercial |
$394.36
|
| Rate for Payer: Anthem Medicaid |
$176.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.48
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cigna Commercial |
$425.08
|
| Rate for Payer: First Health Commercial |
$486.54
|
| Rate for Payer: Humana Commercial |
$435.33
|
| Rate for Payer: Humana KY Medicaid |
$176.13
|
| Rate for Payer: Kentucky WC Medicaid |
$177.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.69
|
| Rate for Payer: Ohio Health Group HMO |
$384.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.38
|
| Rate for Payer: PHCS Commercial |
$491.66
|
| Rate for Payer: United Healthcare All Payer |
$450.69
|
|
|
PIGTAIL 5FR 65CM
|
Facility
|
IP
|
$512.15
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.65 |
| Max. Negotiated Rate |
$491.66 |
| Rate for Payer: Aetna Commercial |
$394.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.48
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cigna Commercial |
$425.08
|
| Rate for Payer: First Health Commercial |
$486.54
|
| Rate for Payer: Humana Commercial |
$435.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.69
|
| Rate for Payer: Ohio Health Group HMO |
$384.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.38
|
| Rate for Payer: PHCS Commercial |
$491.66
|
| Rate for Payer: United Healthcare All Payer |
$450.69
|
|
|
PIGTAIL 5FR 90CM
|
Facility
|
IP
|
$512.15
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.65 |
| Max. Negotiated Rate |
$491.66 |
| Rate for Payer: Aetna Commercial |
$394.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.48
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cigna Commercial |
$425.08
|
| Rate for Payer: First Health Commercial |
$486.54
|
| Rate for Payer: Humana Commercial |
$435.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.69
|
| Rate for Payer: Ohio Health Group HMO |
$384.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.38
|
| Rate for Payer: PHCS Commercial |
$491.66
|
| Rate for Payer: United Healthcare All Payer |
$450.69
|
|
|
PIGTAIL 5FR 90CM
|
Facility
|
OP
|
$512.15
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.65 |
| Max. Negotiated Rate |
$491.66 |
| Rate for Payer: Aetna Commercial |
$394.36
|
| Rate for Payer: Anthem Medicaid |
$176.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.48
|
| Rate for Payer: Cash Price |
$256.08
|
| Rate for Payer: Cigna Commercial |
$425.08
|
| Rate for Payer: First Health Commercial |
$486.54
|
| Rate for Payer: Humana Commercial |
$435.33
|
| Rate for Payer: Humana KY Medicaid |
$176.13
|
| Rate for Payer: Kentucky WC Medicaid |
$177.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.69
|
| Rate for Payer: Ohio Health Group HMO |
$384.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.38
|
| Rate for Payer: PHCS Commercial |
$491.66
|
| Rate for Payer: United Healthcare All Payer |
$450.69
|
|
|
PIGTAIL 6F 110CM
|
Facility
|
IP
|
$168.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
PIGTAIL 6F 110CM
|
Facility
|
OP
|
$168.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem Medicaid |
$58.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Humana KY Medicaid |
$58.03
|
| Rate for Payer: Kentucky WC Medicaid |
$58.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
PIGTAIL ST. 4FR 90CM
|
Facility
|
IP
|
$498.65
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.59 |
| Max. Negotiated Rate |
$478.70 |
| Rate for Payer: Aetna Commercial |
$383.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$388.95
|
| Rate for Payer: Cash Price |
$249.32
|
| Rate for Payer: Cigna Commercial |
$413.88
|
| Rate for Payer: First Health Commercial |
$473.72
|
| Rate for Payer: Humana Commercial |
$423.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$408.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$438.81
|
| Rate for Payer: Ohio Health Group HMO |
$373.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.07
|
| Rate for Payer: PHCS Commercial |
$478.70
|
| Rate for Payer: United Healthcare All Payer |
$438.81
|
|
|
PIGTAIL ST. 4FR 90CM
|
Facility
|
OP
|
$498.65
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.59 |
| Max. Negotiated Rate |
$478.70 |
| Rate for Payer: Aetna Commercial |
$383.96
|
| Rate for Payer: Anthem Medicaid |
$171.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$388.95
|
| Rate for Payer: Cash Price |
$249.32
|
| Rate for Payer: Cigna Commercial |
$413.88
|
| Rate for Payer: First Health Commercial |
$473.72
|
| Rate for Payer: Humana Commercial |
$423.85
|
| Rate for Payer: Humana KY Medicaid |
$171.49
|
| Rate for Payer: Kentucky WC Medicaid |
$173.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$408.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$438.81
|
| Rate for Payer: Ohio Health Group HMO |
$373.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.07
|
| Rate for Payer: PHCS Commercial |
$478.70
|
| Rate for Payer: United Healthcare All Payer |
$438.81
|
|
|
PIGTAIL STR. 5F 110CM
|
Facility
|
IP
|
$520.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.07 |
| Max. Negotiated Rate |
$499.44 |
| Rate for Payer: Aetna Commercial |
$400.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.80
|
| Rate for Payer: Cash Price |
$260.12
|
| Rate for Payer: Cigna Commercial |
$431.81
|
| Rate for Payer: First Health Commercial |
$494.24
|
| Rate for Payer: Humana Commercial |
$442.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.82
|
| Rate for Payer: Ohio Health Group HMO |
$390.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.97
|
| Rate for Payer: PHCS Commercial |
$499.44
|
| Rate for Payer: United Healthcare All Payer |
$457.82
|
|
|
PIGTAIL STR. 5F 110CM
|
Facility
|
OP
|
$520.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.07 |
| Max. Negotiated Rate |
$499.44 |
| Rate for Payer: Aetna Commercial |
$400.59
|
| Rate for Payer: Anthem Medicaid |
$178.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.80
|
| Rate for Payer: Cash Price |
$260.12
|
| Rate for Payer: Cigna Commercial |
$431.81
|
| Rate for Payer: First Health Commercial |
$494.24
|
| Rate for Payer: Humana Commercial |
$442.21
|
| Rate for Payer: Humana KY Medicaid |
$178.91
|
| Rate for Payer: Kentucky WC Medicaid |
$180.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.82
|
| Rate for Payer: Ohio Health Group HMO |
$390.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.97
|
| Rate for Payer: PHCS Commercial |
$499.44
|
| Rate for Payer: United Healthcare All Payer |
$457.82
|
|
|
PILOCARPINE 1% EYE DROPS
|
Facility
|
IP
|
$1.03
|
|
|
Service Code
|
NDC 70069018101
|
| Hospital Charge Code |
25001186
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: First Health Commercial |
$0.98
|
| Rate for Payer: Humana Commercial |
$0.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.91
|
| Rate for Payer: Ohio Health Group HMO |
$0.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.71
|
| Rate for Payer: PHCS Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Payer |
$0.91
|
|
|
PILOCARPINE 1% EYE DROPS
|
Facility
|
OP
|
$1.03
|
|
|
Service Code
|
NDC 70069018101
|
| Hospital Charge Code |
25001186
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Anthem Medicaid |
$0.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: Cigna Commercial |
$0.85
|
| Rate for Payer: First Health Commercial |
$0.98
|
| Rate for Payer: Humana Commercial |
$0.88
|
| Rate for Payer: Humana KY Medicaid |
$0.35
|
| Rate for Payer: Kentucky WC Medicaid |
$0.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.91
|
| Rate for Payer: Ohio Health Group HMO |
$0.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.71
|
| Rate for Payer: PHCS Commercial |
$0.99
|
| Rate for Payer: United Healthcare All Payer |
$0.91
|
|
|
PIN ACL TGHTROPE 4MM OPEN
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Kentucky WC Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
PIN ACL TGHTROPE 4MM OPEN
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
PIN BUSHING ELBOW RPL KIT XSM
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
PIN BUSHING ELBOW RPL KIT XSM
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
PIN FINGER DISLOCATION
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 26776
|
| Hospital Charge Code |
76102603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.27 |
| Max. Negotiated Rate |
$700.72 |
| Rate for Payer: Aetna Commercial |
$618.54
|
| Rate for Payer: Ambetter Exchange |
$430.66
|
| Rate for Payer: Anthem Medicaid |
$199.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$430.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$430.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$516.79
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$700.72
|
| Rate for Payer: Healthspan PPO |
$560.27
|
| Rate for Payer: Humana Medicaid |
$199.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$535.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$430.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$430.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.26
|
| Rate for Payer: Molina Healthcare Passport |
$199.27
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$559.86
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$430.66
|
|
