|
PLACE RADIOTHER BALLOON CATH(T
|
Facility
|
IP
|
$3,810.50
|
|
|
Service Code
|
HCPCS 19297
|
| Hospital Charge Code |
761T0298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,143.15 |
| Max. Negotiated Rate |
$3,658.08 |
| Rate for Payer: Aetna Commercial |
$2,934.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,972.19
|
| Rate for Payer: Cash Price |
$1,905.25
|
| Rate for Payer: Cigna Commercial |
$3,162.72
|
| Rate for Payer: First Health Commercial |
$3,619.97
|
| Rate for Payer: Humana Commercial |
$3,238.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,124.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,812.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,143.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,353.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,857.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,048.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,315.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,629.24
|
| Rate for Payer: PHCS Commercial |
$3,658.08
|
| Rate for Payer: United Healthcare All Payer |
$3,353.24
|
|
|
PLACE RT DEVICE/MARKER PROS
|
Professional
|
Both
|
$4,052.00
|
|
|
Service Code
|
HCPCS 55876
|
| Hospital Charge Code |
76102153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$2,431.20 |
| Rate for Payer: Aetna Commercial |
$178.67
|
| Rate for Payer: Ambetter Exchange |
$96.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.55
|
| Rate for Payer: Anthem Medicaid |
$108.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$96.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.34
|
| Rate for Payer: Cash Price |
$2,026.00
|
| Rate for Payer: Cash Price |
$2,026.00
|
| Rate for Payer: Cigna Commercial |
$220.44
|
| Rate for Payer: Healthspan PPO |
$224.30
|
| Rate for Payer: Humana Medicaid |
$108.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$137.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$96.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.85
|
| Rate for Payer: Molina Healthcare Passport |
$108.68
|
| Rate for Payer: Multiplan PHCS |
$2,431.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$124.96
|
| Rate for Payer: UHCCP Medicaid |
$62.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$109.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$96.12
|
|
|
PLACE RT DEVICE/MARKER PROS
|
Facility
|
IP
|
$4,052.00
|
|
|
Service Code
|
HCPCS 55876
|
| Hospital Charge Code |
76102153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,215.60 |
| Max. Negotiated Rate |
$3,889.92 |
| Rate for Payer: Aetna Commercial |
$3,120.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,160.56
|
| Rate for Payer: Cash Price |
$2,026.00
|
| Rate for Payer: Cigna Commercial |
$3,363.16
|
| Rate for Payer: First Health Commercial |
$3,849.40
|
| Rate for Payer: Humana Commercial |
$3,444.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,322.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,990.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,215.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,565.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,039.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,525.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,795.88
|
| Rate for Payer: PHCS Commercial |
$3,889.92
|
| Rate for Payer: United Healthcare All Payer |
$3,565.76
|
|
|
PLACE RT DEVICE/MARKER PROS
|
Facility
|
OP
|
$4,052.00
|
|
|
Service Code
|
HCPCS 55876
|
| Hospital Charge Code |
76102153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,264.24 |
| Max. Negotiated Rate |
$3,889.92 |
| Rate for Payer: Aetna Commercial |
$3,120.04
|
| Rate for Payer: Anthem Medicaid |
$1,393.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,264.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,160.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,769.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,706.72
|
| Rate for Payer: Cash Price |
$2,026.00
|
| Rate for Payer: Cash Price |
$2,026.00
|
| Rate for Payer: Cigna Commercial |
$3,363.16
|
| Rate for Payer: First Health Commercial |
$3,849.40
|
| Rate for Payer: Humana Commercial |
$3,444.20
|
| Rate for Payer: Humana KY Medicaid |
$1,393.48
|
| Rate for Payer: Humana Medicare Advantage |
$1,264.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,407.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,322.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,990.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,517.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,565.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,039.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,525.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,795.88
|
| Rate for Payer: PHCS Commercial |
$3,889.92
|
| Rate for Payer: United Healthcare All Payer |
$3,565.76
|
|
|
PLACE RT DEVICE/MARKER PROS(P
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 55876
|
| Hospital Charge Code |
761P2153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$178.67
|
| Rate for Payer: Ambetter Exchange |
$96.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.55
|
| Rate for Payer: Anthem Medicaid |
$108.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$96.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.34
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$220.44
|
| Rate for Payer: Healthspan PPO |
$224.30
|
| Rate for Payer: Humana Medicaid |
$108.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$137.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$96.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.85
|
| Rate for Payer: Molina Healthcare Passport |
$108.68
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$124.96
|
| Rate for Payer: UHCCP Medicaid |
$62.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$109.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$96.12
|
|
|
PLACE RT DEVICE/MARKER PROS(T
|
Facility
|
OP
|
$3,677.00
|
|
|
Service Code
|
HCPCS 55876
|
| Hospital Charge Code |
761T2153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,264.24 |
| Max. Negotiated Rate |
$3,529.92 |
| Rate for Payer: Aetna Commercial |
$2,831.29
|
| Rate for Payer: Anthem Medicaid |
$1,264.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,264.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,868.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,769.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,706.72
|
| Rate for Payer: Cash Price |
$1,838.50
|
| Rate for Payer: Cash Price |
$1,838.50
|
| Rate for Payer: Cigna Commercial |
$3,051.91
|
| Rate for Payer: First Health Commercial |
$3,493.15
|
| Rate for Payer: Humana Commercial |
$3,125.45
|
| Rate for Payer: Humana KY Medicaid |
$1,264.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,264.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,277.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,015.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,713.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,517.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,289.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,235.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,757.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,941.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,537.13
|
| Rate for Payer: PHCS Commercial |
$3,529.92
|
| Rate for Payer: United Healthcare All Payer |
$3,235.76
|
|
|
PLACE RT DEVICE/MARKER PROS(T
|
Facility
|
IP
|
$3,677.00
|
|
|
Service Code
|
HCPCS 55876
|
| Hospital Charge Code |
761T2153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,103.10 |
| Max. Negotiated Rate |
$3,529.92 |
| Rate for Payer: Aetna Commercial |
$2,831.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,868.06
|
| Rate for Payer: Cash Price |
$1,838.50
|
| Rate for Payer: Cigna Commercial |
$3,051.91
|
| Rate for Payer: First Health Commercial |
$3,493.15
|
| Rate for Payer: Humana Commercial |
$3,125.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,015.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,713.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,103.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,235.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,757.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,941.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,537.13
|
| Rate for Payer: PHCS Commercial |
$3,529.92
|
| Rate for Payer: United Healthcare All Payer |
$3,235.76
|
|
|
PLANT PROFYLE REPLANT 4*2H
|
Facility
|
IP
|
$4,223.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.90 |
| Max. Negotiated Rate |
$4,054.08 |
| Rate for Payer: Aetna Commercial |
$3,251.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,293.94
|
| Rate for Payer: Cash Price |
$2,111.50
|
| Rate for Payer: Cigna Commercial |
$3,505.09
|
| Rate for Payer: First Health Commercial |
$4,011.85
|
| Rate for Payer: Humana Commercial |
$3,589.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,116.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,716.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,167.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,674.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,913.87
|
| Rate for Payer: PHCS Commercial |
$4,054.08
|
| Rate for Payer: United Healthcare All Payer |
$3,716.24
|
|
|
PLANT PROFYLE REPLANT 4*2H
|
Facility
|
OP
|
$4,223.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.90 |
| Max. Negotiated Rate |
$4,054.08 |
| Rate for Payer: Aetna Commercial |
$3,251.71
|
| Rate for Payer: Anthem Medicaid |
$1,452.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,293.94
|
| Rate for Payer: Cash Price |
$2,111.50
|
| Rate for Payer: Cigna Commercial |
$3,505.09
|
| Rate for Payer: First Health Commercial |
$4,011.85
|
| Rate for Payer: Humana Commercial |
$3,589.55
|
| Rate for Payer: Humana KY Medicaid |
$1,452.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,467.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,116.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,481.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,716.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,167.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,674.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,913.87
|
| Rate for Payer: PHCS Commercial |
$4,054.08
|
| Rate for Payer: United Healthcare All Payer |
$3,716.24
|
|
|
PLAQUENIL(HYDROXYCH 200MG/1TAB
|
Facility
|
IP
|
$9.95
|
|
|
Service Code
|
NDC 68084026901
|
| Hospital Charge Code |
25001190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$7.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.76
|
| Rate for Payer: Cash Price |
$4.97
|
| Rate for Payer: Cigna Commercial |
$8.26
|
| Rate for Payer: First Health Commercial |
$9.45
|
| Rate for Payer: Humana Commercial |
$8.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.76
|
| Rate for Payer: Ohio Health Group HMO |
$7.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.87
|
| Rate for Payer: PHCS Commercial |
$9.55
|
| Rate for Payer: United Healthcare All Payer |
$8.76
|
|
|
PLAQUENIL(HYDROXYCH 200MG/1TAB
|
Facility
|
OP
|
$9.95
|
|
|
Service Code
|
NDC 68084026901
|
| Hospital Charge Code |
25001190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$7.66
|
| Rate for Payer: Anthem Medicaid |
$3.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.76
|
| Rate for Payer: Cash Price |
$4.97
|
| Rate for Payer: Cigna Commercial |
$8.26
|
| Rate for Payer: First Health Commercial |
$9.45
|
| Rate for Payer: Humana Commercial |
$8.46
|
| Rate for Payer: Humana KY Medicaid |
$3.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.76
|
| Rate for Payer: Ohio Health Group HMO |
$7.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.87
|
| Rate for Payer: PHCS Commercial |
$9.55
|
| Rate for Payer: United Healthcare All Payer |
$8.76
|
|
|
PLASMAX CONCENTRATOR C-BAL
|
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
|
|
|
PLASMAX CONCENTRATOR C-BAL
|
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
|
|
|
PLASMAX MINI KIT W/30M ACDA
|
Facility
|
OP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem Medicaid |
$2,849.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Humana KY Medicaid |
$2,849.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,878.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,906.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
PLASMAX MINI KIT W/30M ACDA
|
Facility
|
IP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
PLASMAX PLUS KIT W/30M ACDA
|
Facility
|
IP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
PLASMAX PLUS KIT W/30M ACDA
|
Facility
|
OP
|
$8,285.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.56 |
| Max. Negotiated Rate |
$7,953.79 |
| Rate for Payer: Aetna Commercial |
$6,379.60
|
| Rate for Payer: Anthem Medicaid |
$2,849.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.46
|
| Rate for Payer: Cash Price |
$4,142.60
|
| Rate for Payer: Cigna Commercial |
$6,876.72
|
| Rate for Payer: First Health Commercial |
$7,870.94
|
| Rate for Payer: Humana Commercial |
$7,042.42
|
| Rate for Payer: Humana KY Medicaid |
$2,849.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,878.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,793.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,906.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,290.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,213.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.79
|
| Rate for Payer: PHCS Commercial |
$7,953.79
|
| Rate for Payer: United Healthcare All Payer |
$7,290.98
|
|
|
PLAS RPR PENIS EPISP DST SNCTR
|
Professional
|
Both
|
$3,547.00
|
|
|
Service Code
|
HCPCS 54380
|
| Hospital Charge Code |
76102135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$640.32 |
| Max. Negotiated Rate |
$2,128.20 |
| Rate for Payer: Aetna Commercial |
$1,315.06
|
| Rate for Payer: Ambetter Exchange |
$756.31
|
| Rate for Payer: Anthem Medicaid |
$640.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$756.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$756.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$907.57
|
| Rate for Payer: Cash Price |
$1,773.50
|
| Rate for Payer: Cash Price |
$1,773.50
|
| Rate for Payer: Cigna Commercial |
$1,149.04
|
| Rate for Payer: Healthspan PPO |
$1,273.31
|
| Rate for Payer: Humana Medicaid |
$640.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,094.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$756.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$756.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$653.13
|
| Rate for Payer: Molina Healthcare Passport |
$640.32
|
| Rate for Payer: Multiplan PHCS |
$2,128.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$983.20
|
| Rate for Payer: UHCCP Medicaid |
$1,241.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$646.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$756.31
|
|
|
PLAS RPR PENIS EPISP DST SNCTR
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 54380
|
| Hospital Charge Code |
761T2135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem Medicaid |
$872.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Humana KY Medicaid |
$872.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$881.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$889.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,029.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,207.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.53
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
PLAS RPR PENIS EPISP DST SNCTR
|
Facility
|
IP
|
$3,547.00
|
|
|
Service Code
|
HCPCS 54380
|
| Hospital Charge Code |
76102135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,064.10 |
| Max. Negotiated Rate |
$3,405.12 |
| Rate for Payer: Aetna Commercial |
$2,731.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,766.66
|
| Rate for Payer: Cash Price |
$1,773.50
|
| Rate for Payer: Cigna Commercial |
$2,944.01
|
| Rate for Payer: First Health Commercial |
$3,369.65
|
| Rate for Payer: Humana Commercial |
$3,014.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,908.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,617.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,064.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,121.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,660.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,837.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,085.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,447.43
|
| Rate for Payer: PHCS Commercial |
$3,405.12
|
| Rate for Payer: United Healthcare All Payer |
$3,121.36
|
|
|
PLAS RPR PENIS EPISP DST SNCTR
|
Professional
|
Both
|
$1,010.00
|
|
|
Service Code
|
HCPCS 54380
|
| Hospital Charge Code |
761P2135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.50 |
| Max. Negotiated Rate |
$1,315.06 |
| Rate for Payer: Aetna Commercial |
$1,315.06
|
| Rate for Payer: Ambetter Exchange |
$756.31
|
| Rate for Payer: Anthem Medicaid |
$640.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$756.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$756.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$907.57
|
| Rate for Payer: Cash Price |
$505.00
|
| Rate for Payer: Cash Price |
$505.00
|
| Rate for Payer: Cigna Commercial |
$1,149.04
|
| Rate for Payer: Healthspan PPO |
$1,273.31
|
| Rate for Payer: Humana Medicaid |
$640.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,094.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$756.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$756.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$653.13
|
| Rate for Payer: Molina Healthcare Passport |
$640.32
|
| Rate for Payer: Multiplan PHCS |
$606.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$983.20
|
| Rate for Payer: UHCCP Medicaid |
$353.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$646.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$756.31
|
|
|
PLAS RPR PENIS EPISP DST SNCTR
|
Facility
|
OP
|
$3,547.00
|
|
|
Service Code
|
HCPCS 54380
|
| Hospital Charge Code |
76102135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,219.81 |
| Max. Negotiated Rate |
$3,405.12 |
| Rate for Payer: Aetna Commercial |
$2,731.19
|
| Rate for Payer: Anthem Medicaid |
$1,219.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,766.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$1,773.50
|
| Rate for Payer: Cash Price |
$1,773.50
|
| Rate for Payer: Cigna Commercial |
$2,944.01
|
| Rate for Payer: First Health Commercial |
$3,369.65
|
| Rate for Payer: Humana Commercial |
$3,014.95
|
| Rate for Payer: Humana KY Medicaid |
$1,219.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,232.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,908.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,617.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,244.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,121.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,660.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,837.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,085.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,447.43
|
| Rate for Payer: PHCS Commercial |
$3,405.12
|
| Rate for Payer: United Healthcare All Payer |
$3,121.36
|
|
|
PLAS RPR PENIS EPISP DST SNCTR
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 54380
|
| Hospital Charge Code |
761T2135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$761.10 |
| Max. Negotiated Rate |
$2,435.52 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$761.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,029.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,207.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.53
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
PLAT CONDYLR LCP 4.5 6H 170M L
|
Facility
|
IP
|
$7,660.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.20 |
| Max. Negotiated Rate |
$7,354.22 |
| Rate for Payer: Aetna Commercial |
$5,898.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,975.31
|
| Rate for Payer: Cash Price |
$3,830.32
|
| Rate for Payer: Cigna Commercial |
$6,358.34
|
| Rate for Payer: First Health Commercial |
$7,277.62
|
| Rate for Payer: Humana Commercial |
$6,511.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,281.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,653.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,741.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,745.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,128.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,664.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,285.85
|
| Rate for Payer: PHCS Commercial |
$7,354.22
|
| Rate for Payer: United Healthcare All Payer |
$6,741.37
|
|
|
PLAT CONDYLR LCP 4.5 6H 170M L
|
Facility
|
OP
|
$7,660.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.20 |
| Max. Negotiated Rate |
$7,354.22 |
| Rate for Payer: Aetna Commercial |
$5,898.70
|
| Rate for Payer: Anthem Medicaid |
$2,634.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,975.31
|
| Rate for Payer: Cash Price |
$3,830.32
|
| Rate for Payer: Cigna Commercial |
$6,358.34
|
| Rate for Payer: First Health Commercial |
$7,277.62
|
| Rate for Payer: Humana Commercial |
$6,511.55
|
| Rate for Payer: Humana KY Medicaid |
$2,634.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,661.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,281.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,653.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,298.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,687.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,741.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,745.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,128.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,664.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,285.85
|
| Rate for Payer: PHCS Commercial |
$7,354.22
|
| Rate for Payer: United Healthcare All Payer |
$6,741.37
|
|
