|
PLATE Z PROFYL LCK 2.3 NAR 13H
|
Facility
|
OP
|
$4,461.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.44 |
| Max. Negotiated Rate |
$4,283.00 |
| Rate for Payer: Aetna Commercial |
$3,435.32
|
| Rate for Payer: Anthem Medicaid |
$1,534.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,479.94
|
| Rate for Payer: Cash Price |
$2,230.73
|
| Rate for Payer: Cigna Commercial |
$3,703.01
|
| Rate for Payer: First Health Commercial |
$4,238.39
|
| Rate for Payer: Humana Commercial |
$3,792.24
|
| Rate for Payer: Humana KY Medicaid |
$1,534.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,549.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,658.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,292.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,926.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,346.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,569.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,881.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,078.41
|
| Rate for Payer: PHCS Commercial |
$4,283.00
|
| Rate for Payer: United Healthcare All Payer |
$3,926.08
|
|
|
PLAT SAG SPLT CVD 6H 6M BARLCK
|
Facility
|
IP
|
$3,048.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.52 |
| Max. Negotiated Rate |
$2,926.45 |
| Rate for Payer: Aetna Commercial |
$2,347.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,377.74
|
| Rate for Payer: Cash Price |
$1,524.19
|
| Rate for Payer: Cigna Commercial |
$2,530.16
|
| Rate for Payer: First Health Commercial |
$2,895.97
|
| Rate for Payer: Humana Commercial |
$2,591.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,499.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,249.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$914.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,682.58
|
| Rate for Payer: Ohio Health Group HMO |
$2,286.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,438.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,652.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,103.39
|
| Rate for Payer: PHCS Commercial |
$2,926.45
|
| Rate for Payer: United Healthcare All Payer |
$2,682.58
|
|
|
PLAT SAG SPLT CVD 6H 6M BARLCK
|
Facility
|
OP
|
$3,048.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.52 |
| Max. Negotiated Rate |
$2,926.45 |
| Rate for Payer: Aetna Commercial |
$2,347.26
|
| Rate for Payer: Anthem Medicaid |
$1,048.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,377.74
|
| Rate for Payer: Cash Price |
$1,524.19
|
| Rate for Payer: Cigna Commercial |
$2,530.16
|
| Rate for Payer: First Health Commercial |
$2,895.97
|
| Rate for Payer: Humana Commercial |
$2,591.13
|
| Rate for Payer: Humana KY Medicaid |
$1,048.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,059.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,499.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,249.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$914.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,069.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,682.58
|
| Rate for Payer: Ohio Health Group HMO |
$2,286.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,438.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,652.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,103.39
|
| Rate for Payer: PHCS Commercial |
$2,926.45
|
| Rate for Payer: United Healthcare All Payer |
$2,682.58
|
|
|
PLAVIX (CLOPIDOGREL)75MG TAB
|
Facility
|
OP
|
$4.46
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
25001191
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.70
|
| Rate for Payer: First Health Commercial |
$4.24
|
| Rate for Payer: Humana Commercial |
$3.79
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
PLAVIX (CLOPIDOGREL)75MG TAB
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
25001191
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.70
|
| Rate for Payer: First Health Commercial |
$4.24
|
| Rate for Payer: Humana Commercial |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
PLAY AUDIO
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 92582
|
| Hospital Charge Code |
47000038
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$208.20 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Ambetter Exchange |
$79.01
|
| Rate for Payer: Anthem Medicaid |
$20.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$79.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$79.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.81
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$49.91
|
| Rate for Payer: Healthspan PPO |
$49.92
|
| Rate for Payer: Humana Medicaid |
$20.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$79.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.61
|
| Rate for Payer: Molina Healthcare Passport |
$20.21
|
| Rate for Payer: Multiplan PHCS |
$208.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.71
|
| Rate for Payer: UHCCP Medicaid |
$121.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$79.01
|
|
|
PLAY AUDIO
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
HCPCS 92582
|
| Hospital Charge Code |
47000038
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$104.10 |
| Max. Negotiated Rate |
$333.12 |
| Rate for Payer: Aetna Commercial |
$267.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$270.66
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$288.01
|
| Rate for Payer: First Health Commercial |
$329.65
|
| Rate for Payer: Humana Commercial |
$294.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$284.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.36
|
| Rate for Payer: Ohio Health Group HMO |
$260.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$301.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.43
|
| Rate for Payer: PHCS Commercial |
$333.12
|
| Rate for Payer: United Healthcare All Payer |
$305.36
|
|
|
PLAY AUDIO
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
HCPCS 92582
|
| Hospital Charge Code |
47000038
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$119.33 |
| Max. Negotiated Rate |
$333.12 |
| Rate for Payer: Aetna Commercial |
$267.19
|
| Rate for Payer: Anthem Medicaid |
$119.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$270.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$288.01
|
| Rate for Payer: First Health Commercial |
$329.65
|
| Rate for Payer: Humana Commercial |
$294.95
|
| Rate for Payer: Humana KY Medicaid |
$119.33
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$120.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$284.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.36
|
| Rate for Payer: Ohio Health Group HMO |
$260.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$301.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.43
|
| Rate for Payer: PHCS Commercial |
$333.12
|
| Rate for Payer: United Healthcare All Payer |
$305.36
|
|
|
PLAY AUDIO(P
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 92582
|
| Hospital Charge Code |
470P0038
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$102.71 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: Ambetter Exchange |
$79.01
|
| Rate for Payer: Anthem Medicaid |
$20.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$79.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$79.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.81
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.91
|
| Rate for Payer: Healthspan PPO |
$49.92
|
| Rate for Payer: Humana Medicaid |
$20.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$79.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.61
|
| Rate for Payer: Molina Healthcare Passport |
$20.21
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.71
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$79.01
|
|
|
PLAY AUDIO(T
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS 92582
|
| Hospital Charge Code |
470T0038
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem Medicaid |
$98.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Humana KY Medicaid |
$98.70
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$99.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
PLAY AUDIO(T
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS 92582
|
| Hospital Charge Code |
470T0038
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
PLCMENT BAKRI TAMPONADE BALLOO
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS 59899
|
| Hospital Charge Code |
76102859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.88 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem Medicaid |
$259.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Humana KY Medicaid |
$259.64
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$262.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.95
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
PLCMENT BAKRI TAMPONADE BALLOO
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 59899
|
| Hospital Charge Code |
76102859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$528.50 |
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$453.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$528.50
|
| Rate for Payer: UHCCP Medicaid |
$264.25
|
|
|
PLCMENT BAKRI TAMPONADE BALLOO
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS 59899
|
| Hospital Charge Code |
76102859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.95
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
PLCMT ATRICLIP DURING CABG
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33999
|
| Hospital Charge Code |
76101335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
|
PLCMT RADIOTH BAL CATH SEP
|
Facility
|
OP
|
$16,100.00
|
|
|
Service Code
|
HCPCS 19296
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,536.79 |
| Max. Negotiated Rate |
$15,456.00 |
| Rate for Payer: Aetna Commercial |
$12,397.00
|
| Rate for Payer: Anthem Medicaid |
$5,536.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,841.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,558.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,378.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,936.17
|
| Rate for Payer: Cash Price |
$8,050.00
|
| Rate for Payer: Cash Price |
$8,050.00
|
| Rate for Payer: Cigna Commercial |
$13,363.00
|
| Rate for Payer: First Health Commercial |
$15,295.00
|
| Rate for Payer: Humana Commercial |
$13,685.00
|
| Rate for Payer: Humana KY Medicaid |
$5,536.79
|
| Rate for Payer: Humana Medicare Advantage |
$8,841.61
|
| Rate for Payer: Kentucky WC Medicaid |
$5,593.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,202.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,881.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,609.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,647.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,007.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,109.00
|
| Rate for Payer: PHCS Commercial |
$15,456.00
|
| Rate for Payer: United Healthcare All Payer |
$14,168.00
|
|
|
PLCMT RADIOTH BAL CATH SEP
|
Professional
|
Both
|
$16,100.00
|
|
|
Service Code
|
HCPCS 19296
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.97 |
| Max. Negotiated Rate |
$9,660.00 |
| Rate for Payer: Aetna Commercial |
$305.84
|
| Rate for Payer: Ambetter Exchange |
$200.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$165.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$200.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$240.24
|
| Rate for Payer: Cash Price |
$8,050.00
|
| Rate for Payer: Cash Price |
$8,050.00
|
| Rate for Payer: Cigna Commercial |
$6,549.88
|
| Rate for Payer: Healthspan PPO |
$4,231.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$200.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.20
|
| Rate for Payer: Multiplan PHCS |
$9,660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$260.26
|
| Rate for Payer: UHCCP Medicaid |
$174.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$200.20
|
|
|
PLCMT RADIOTH BAL CATH SEP
|
Facility
|
IP
|
$16,100.00
|
|
|
Service Code
|
HCPCS 19296
|
| Hospital Charge Code |
76100297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,830.00 |
| Max. Negotiated Rate |
$15,456.00 |
| Rate for Payer: Aetna Commercial |
$12,397.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,558.00
|
| Rate for Payer: Cash Price |
$8,050.00
|
| Rate for Payer: Cigna Commercial |
$13,363.00
|
| Rate for Payer: First Health Commercial |
$15,295.00
|
| Rate for Payer: Humana Commercial |
$13,685.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,202.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,881.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,830.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,007.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,109.00
|
| Rate for Payer: PHCS Commercial |
$15,456.00
|
| Rate for Payer: United Healthcare All Payer |
$14,168.00
|
|
|
PLCMT RADIOTH BAL CATH SEP(P
|
Professional
|
Both
|
$6,291.00
|
|
|
Service Code
|
HCPCS 19296
|
| Hospital Charge Code |
761P0297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.97 |
| Max. Negotiated Rate |
$6,549.88 |
| Rate for Payer: Aetna Commercial |
$305.84
|
| Rate for Payer: Ambetter Exchange |
$200.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$165.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$200.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$240.24
|
| Rate for Payer: Cash Price |
$3,145.50
|
| Rate for Payer: Cash Price |
$3,145.50
|
| Rate for Payer: Cigna Commercial |
$6,549.88
|
| Rate for Payer: Healthspan PPO |
$4,231.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$200.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.20
|
| Rate for Payer: Multiplan PHCS |
$3,774.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$260.26
|
| Rate for Payer: UHCCP Medicaid |
$174.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$200.20
|
|
|
PLCMT RADIOTH BAL CATH SEP(T
|
Facility
|
OP
|
$9,809.00
|
|
|
Service Code
|
HCPCS 19296
|
| Hospital Charge Code |
761T0297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,373.32 |
| Max. Negotiated Rate |
$12,378.25 |
| Rate for Payer: Aetna Commercial |
$7,552.93
|
| Rate for Payer: Anthem Medicaid |
$3,373.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,841.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,651.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,378.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,936.17
|
| Rate for Payer: Cash Price |
$4,904.50
|
| Rate for Payer: Cash Price |
$4,904.50
|
| Rate for Payer: Cigna Commercial |
$8,141.47
|
| Rate for Payer: First Health Commercial |
$9,318.55
|
| Rate for Payer: Humana Commercial |
$8,337.65
|
| Rate for Payer: Humana KY Medicaid |
$3,373.32
|
| Rate for Payer: Humana Medicare Advantage |
$8,841.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,407.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,043.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,239.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,609.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,441.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,631.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,356.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,847.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,533.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,768.21
|
| Rate for Payer: PHCS Commercial |
$9,416.64
|
| Rate for Payer: United Healthcare All Payer |
$8,631.92
|
|
|
PLCMT RADIOTH BAL CATH SEP(T
|
Facility
|
IP
|
$9,809.00
|
|
|
Service Code
|
HCPCS 19296
|
| Hospital Charge Code |
761T0297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,942.70 |
| Max. Negotiated Rate |
$9,416.64 |
| Rate for Payer: Aetna Commercial |
$7,552.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,651.02
|
| Rate for Payer: Cash Price |
$4,904.50
|
| Rate for Payer: Cigna Commercial |
$8,141.47
|
| Rate for Payer: First Health Commercial |
$9,318.55
|
| Rate for Payer: Humana Commercial |
$8,337.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,043.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,239.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,942.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,631.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,356.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,847.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,533.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,768.21
|
| Rate for Payer: PHCS Commercial |
$9,416.64
|
| Rate for Payer: United Healthcare All Payer |
$8,631.92
|
|
|
PLENDIL (FELODIPINE) 10 MG TAB
|
Facility
|
OP
|
$4.88
|
|
|
Service Code
|
NDC 13668013401
|
| Hospital Charge Code |
25001194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Anthem Medicaid |
$1.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.05
|
| Rate for Payer: First Health Commercial |
$4.64
|
| Rate for Payer: Humana Commercial |
$4.15
|
| Rate for Payer: Humana KY Medicaid |
$1.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.37
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
PLENDIL (FELODIPINE) 10 MG TAB
|
Facility
|
IP
|
$4.88
|
|
|
Service Code
|
NDC 13668013401
|
| Hospital Charge Code |
25001194
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.05
|
| Rate for Payer: First Health Commercial |
$4.64
|
| Rate for Payer: Humana Commercial |
$4.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.37
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
PLENDIL (FELODIPINE) 2.5MG TAB
|
Facility
|
IP
|
$9.09
|
|
|
Service Code
|
NDC 53489036801
|
| Hospital Charge Code |
25001195
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.09
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna Commercial |
$7.54
|
| Rate for Payer: First Health Commercial |
$8.64
|
| Rate for Payer: Humana Commercial |
$7.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.00
|
| Rate for Payer: Ohio Health Group HMO |
$6.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.27
|
| Rate for Payer: PHCS Commercial |
$8.73
|
| Rate for Payer: United Healthcare All Payer |
$8.00
|
|
|
PLENDIL (FELODIPINE) 2.5MG TAB
|
Facility
|
OP
|
$9.09
|
|
|
Service Code
|
NDC 53489036801
|
| Hospital Charge Code |
25001195
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: Anthem Medicaid |
$3.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.09
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna Commercial |
$7.54
|
| Rate for Payer: First Health Commercial |
$8.64
|
| Rate for Payer: Humana Commercial |
$7.73
|
| Rate for Payer: Humana KY Medicaid |
$3.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.00
|
| Rate for Payer: Ohio Health Group HMO |
$6.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.27
|
| Rate for Payer: PHCS Commercial |
$8.73
|
| Rate for Payer: United Healthcare All Payer |
$8.00
|
|
