|
PIN TEMP SMOOTH 1.1*15MM
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem Medicaid |
$510.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Humana KY Medicaid |
$510.69
|
| Rate for Payer: Kentucky WC Medicaid |
$515.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
PIN WORM SLIDE
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 87172
|
| Hospital Charge Code |
30001314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.35
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.81
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
PIN WORM SLIDE
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 87172
|
| Hospital Charge Code |
30001314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.81
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
PIN-X 144MG/ML/30 ML ORAL SUSP
|
Facility
|
OP
|
$23.03
|
|
|
Service Code
|
NDC 23513061801
|
| Hospital Charge Code |
25001188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: Anthem Medicaid |
$7.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.96
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: Cigna Commercial |
$19.11
|
| Rate for Payer: First Health Commercial |
$21.88
|
| Rate for Payer: Humana Commercial |
$19.58
|
| Rate for Payer: Humana KY Medicaid |
$7.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.27
|
| Rate for Payer: Ohio Health Group HMO |
$17.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.89
|
| Rate for Payer: PHCS Commercial |
$22.11
|
| Rate for Payer: United Healthcare All Payer |
$20.27
|
|
|
PIN-X 144MG/ML/30 ML ORAL SUSP
|
Facility
|
IP
|
$23.03
|
|
|
Service Code
|
NDC 23513061801
|
| Hospital Charge Code |
25001188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.96
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: Cigna Commercial |
$19.11
|
| Rate for Payer: First Health Commercial |
$21.88
|
| Rate for Payer: Humana Commercial |
$19.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.27
|
| Rate for Payer: Ohio Health Group HMO |
$17.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.89
|
| Rate for Payer: PHCS Commercial |
$22.11
|
| Rate for Payer: United Healthcare All Payer |
$20.27
|
|
|
PIONEER PLUS CATH
|
Facility
|
OP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem Medicaid |
$4,674.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Humana KY Medicaid |
$4,674.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,722.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
PIONEER PLUS CATH
|
Facility
|
IP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
PITOCIN LDRP 30MG/500ML
|
Facility
|
IP
|
$105.63
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
25002319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.69 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$82.39
|
| Rate for Payer: Cash Price |
$52.81
|
| Rate for Payer: Cigna Commercial |
$87.67
|
| Rate for Payer: First Health Commercial |
$100.35
|
| Rate for Payer: Humana Commercial |
$89.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.95
|
| Rate for Payer: Ohio Health Group HMO |
$79.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.88
|
| Rate for Payer: PHCS Commercial |
$101.40
|
| Rate for Payer: United Healthcare All Payer |
$92.95
|
|
|
PITOCIN LDRP 30MG/500ML
|
Facility
|
OP
|
$105.63
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
25002319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.69 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Anthem Medicaid |
$36.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$82.39
|
| Rate for Payer: Cash Price |
$52.81
|
| Rate for Payer: Cigna Commercial |
$87.67
|
| Rate for Payer: First Health Commercial |
$100.35
|
| Rate for Payer: Humana Commercial |
$89.79
|
| Rate for Payer: Humana KY Medicaid |
$36.33
|
| Rate for Payer: Kentucky WC Medicaid |
$36.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.95
|
| Rate for Payer: Ohio Health Group HMO |
$79.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.88
|
| Rate for Payer: PHCS Commercial |
$101.40
|
| Rate for Payer: United Healthcare All Payer |
$92.95
|
|
|
PITOCIN(OXYTOCIN)10U/1ML(UP TO
|
Facility
|
IP
|
$79.60
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
25002320
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$76.42 |
| Rate for Payer: Aetna Commercial |
$61.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.09
|
| Rate for Payer: Cash Price |
$39.80
|
| Rate for Payer: Cigna Commercial |
$66.07
|
| Rate for Payer: First Health Commercial |
$75.62
|
| Rate for Payer: Humana Commercial |
$67.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.05
|
| Rate for Payer: Ohio Health Group HMO |
$59.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.92
|
| Rate for Payer: PHCS Commercial |
$76.42
|
| Rate for Payer: United Healthcare All Payer |
$70.05
|
|
|
PITOCIN(OXYTOCIN)10U/1ML(UP TO
|
Facility
|
OP
|
$79.60
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
25002320
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$76.42 |
| Rate for Payer: Aetna Commercial |
$61.29
|
| Rate for Payer: Anthem Medicaid |
$27.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.09
|
| Rate for Payer: Cash Price |
$39.80
|
| Rate for Payer: Cigna Commercial |
$66.07
|
| Rate for Payer: First Health Commercial |
$75.62
|
| Rate for Payer: Humana Commercial |
$67.66
|
| Rate for Payer: Humana KY Medicaid |
$27.37
|
| Rate for Payer: Kentucky WC Medicaid |
$27.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.05
|
| Rate for Payer: Ohio Health Group HMO |
$59.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.92
|
| Rate for Payer: PHCS Commercial |
$76.42
|
| Rate for Payer: United Healthcare All Payer |
$70.05
|
|
|
PIVOT 1.5 CAL (8 OZ CAN) TF
|
Facility
|
IP
|
$70.16
|
|
|
Service Code
|
NDC 70074058014
|
| Hospital Charge Code |
25001189
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$67.35 |
| Rate for Payer: Aetna Commercial |
$54.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.72
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: Cigna Commercial |
$58.23
|
| Rate for Payer: First Health Commercial |
$66.65
|
| Rate for Payer: Humana Commercial |
$59.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.74
|
| Rate for Payer: Ohio Health Group HMO |
$52.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.41
|
| Rate for Payer: PHCS Commercial |
$67.35
|
| Rate for Payer: United Healthcare All Payer |
$61.74
|
|
|
PIVOT 1.5 CAL (8 OZ CAN) TF
|
Facility
|
OP
|
$70.16
|
|
|
Service Code
|
NDC 70074058014
|
| Hospital Charge Code |
25001189
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$67.35 |
| Rate for Payer: Aetna Commercial |
$54.02
|
| Rate for Payer: Anthem Medicaid |
$24.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.72
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: Cigna Commercial |
$58.23
|
| Rate for Payer: First Health Commercial |
$66.65
|
| Rate for Payer: Humana Commercial |
$59.64
|
| Rate for Payer: Humana KY Medicaid |
$24.13
|
| Rate for Payer: Kentucky WC Medicaid |
$24.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.74
|
| Rate for Payer: Ohio Health Group HMO |
$52.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.41
|
| Rate for Payer: PHCS Commercial |
$67.35
|
| Rate for Payer: United Healthcare All Payer |
$61.74
|
|
|
PIVOT READY TO HAND 1000ML
|
Facility
|
IP
|
$108.07
|
|
| Hospital Charge Code |
27000099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$103.75 |
| Rate for Payer: Aetna Commercial |
$83.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.29
|
| Rate for Payer: Cash Price |
$54.03
|
| Rate for Payer: Cigna Commercial |
$89.70
|
| Rate for Payer: First Health Commercial |
$102.67
|
| Rate for Payer: Humana Commercial |
$91.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.10
|
| Rate for Payer: Ohio Health Group HMO |
$81.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.57
|
| Rate for Payer: PHCS Commercial |
$103.75
|
| Rate for Payer: United Healthcare All Payer |
$95.10
|
|
|
PIVOT READY TO HAND 1000ML
|
Facility
|
OP
|
$98.08
|
|
|
Service Code
|
NDC 70074062719
|
| Hospital Charge Code |
27000099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna Commercial |
$75.52
|
| Rate for Payer: Anthem Medicaid |
$33.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.50
|
| Rate for Payer: Cash Price |
$49.04
|
| Rate for Payer: Cigna Commercial |
$81.41
|
| Rate for Payer: First Health Commercial |
$93.18
|
| Rate for Payer: Humana Commercial |
$83.37
|
| Rate for Payer: Humana KY Medicaid |
$33.73
|
| Rate for Payer: Kentucky WC Medicaid |
$34.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.31
|
| Rate for Payer: Ohio Health Group HMO |
$73.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.68
|
| Rate for Payer: PHCS Commercial |
$94.16
|
| Rate for Payer: United Healthcare All Payer |
$86.31
|
|
|
PIVOT READY TO HAND 1000ML
|
Facility
|
OP
|
$108.07
|
|
| Hospital Charge Code |
27000099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$103.75 |
| Rate for Payer: Aetna Commercial |
$83.21
|
| Rate for Payer: Anthem Medicaid |
$37.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.29
|
| Rate for Payer: Cash Price |
$54.03
|
| Rate for Payer: Cigna Commercial |
$89.70
|
| Rate for Payer: First Health Commercial |
$102.67
|
| Rate for Payer: Humana Commercial |
$91.86
|
| Rate for Payer: Humana KY Medicaid |
$37.17
|
| Rate for Payer: Kentucky WC Medicaid |
$37.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.10
|
| Rate for Payer: Ohio Health Group HMO |
$81.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.57
|
| Rate for Payer: PHCS Commercial |
$103.75
|
| Rate for Payer: United Healthcare All Payer |
$95.10
|
|
|
PIVOT READY TO HAND 1000ML
|
Facility
|
IP
|
$98.08
|
|
|
Service Code
|
NDC 70074062719
|
| Hospital Charge Code |
27000099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna Commercial |
$75.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.50
|
| Rate for Payer: Cash Price |
$49.04
|
| Rate for Payer: Cigna Commercial |
$81.41
|
| Rate for Payer: First Health Commercial |
$93.18
|
| Rate for Payer: Humana Commercial |
$83.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.31
|
| Rate for Payer: Ohio Health Group HMO |
$73.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.68
|
| Rate for Payer: PHCS Commercial |
$94.16
|
| Rate for Payer: United Healthcare All Payer |
$86.31
|
|
|
PKR BASEPLATE #1 LM/RL
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #1 LM/RL
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #1 RM / LL
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #1 RM / LL
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #2LM/RL
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #2LM/RL
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #2 RM / LL
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #2 RM / LL
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
