|
PLENDIL (FELODIPINE) 5MG/1TAB
|
Facility
|
OP
|
$4.58
|
|
|
Service Code
|
NDC 13668013301
|
| Hospital Charge Code |
25001193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.80
|
| Rate for Payer: First Health Commercial |
$4.35
|
| Rate for Payer: Humana Commercial |
$3.89
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.03
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.16
|
| Rate for Payer: PHCS Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Payer |
$4.03
|
|
|
PLENDIL (FELODIPINE) 5MG/1TAB
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
NDC 13668013301
|
| Hospital Charge Code |
25001193
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.80
|
| Rate for Payer: First Health Commercial |
$4.35
|
| Rate for Payer: Humana Commercial |
$3.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.03
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.16
|
| Rate for Payer: PHCS Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Payer |
$4.03
|
|
|
PLETAL (CILOSTAZOL) 100MG TAB
|
Facility
|
OP
|
$9.07
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
25001196
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Aetna Commercial |
$6.98
|
| Rate for Payer: Anthem Medicaid |
$3.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.07
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna Commercial |
$7.53
|
| Rate for Payer: First Health Commercial |
$8.62
|
| Rate for Payer: Humana Commercial |
$7.71
|
| Rate for Payer: Humana KY Medicaid |
$3.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.98
|
| Rate for Payer: Ohio Health Group HMO |
$6.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.26
|
| Rate for Payer: PHCS Commercial |
$8.71
|
| Rate for Payer: United Healthcare All Payer |
$7.98
|
|
|
PLETAL (CILOSTAZOL) 100MG TAB
|
Facility
|
IP
|
$9.07
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
25001196
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Aetna Commercial |
$6.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.07
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna Commercial |
$7.53
|
| Rate for Payer: First Health Commercial |
$8.62
|
| Rate for Payer: Humana Commercial |
$7.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.98
|
| Rate for Payer: Ohio Health Group HMO |
$6.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.26
|
| Rate for Payer: PHCS Commercial |
$8.71
|
| Rate for Payer: United Healthcare All Payer |
$7.98
|
|
|
PLEURAL DRAINAGE, PERCUTANEOUS, WITH INSERTION OF INDWELLING CATHETER; WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$2,453.89
|
|
|
Service Code
|
CPT 32556
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,752.78 |
| Max. Negotiated Rate |
$2,453.89 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
|
|
PLEURAL FL CELL CT/DIFF
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem Medicaid |
$5.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Humana KY Medicaid |
$5.60
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
PLEURAL FL CELL CT/DIFF
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$74.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.89
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cigna Commercial |
$80.51
|
| Rate for Payer: First Health Commercial |
$92.15
|
| Rate for Payer: Humana Commercial |
$82.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.36
|
| Rate for Payer: Ohio Health Group HMO |
$72.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.93
|
| Rate for Payer: PHCS Commercial |
$93.12
|
| Rate for Payer: United Healthcare All Payer |
$85.36
|
|
|
PLEURAL SCARIFICATIN RPT PNTHX
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32215
|
| Hospital Charge Code |
761P1182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.98 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,323.49
|
| Rate for Payer: Ambetter Exchange |
$757.64
|
| Rate for Payer: Anthem Medicaid |
$530.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$757.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$757.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$909.17
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,256.23
|
| Rate for Payer: Healthspan PPO |
$1,033.34
|
| Rate for Payer: Humana Medicaid |
$530.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,102.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$757.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$757.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.60
|
| Rate for Payer: Molina Healthcare Passport |
$530.98
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$984.93
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$536.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$757.64
|
|
|
PLEURAL SCARIFICATIN RPT PNTHX
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32215
|
| Hospital Charge Code |
76101182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
PLEURAL SCARIFICATIN RPT PNTHX
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32215
|
| Hospital Charge Code |
76101182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.98 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,323.49
|
| Rate for Payer: Ambetter Exchange |
$757.64
|
| Rate for Payer: Anthem Medicaid |
$530.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$757.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$757.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$909.17
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,256.23
|
| Rate for Payer: Healthspan PPO |
$1,033.34
|
| Rate for Payer: Humana Medicaid |
$530.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,102.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$757.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$757.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.60
|
| Rate for Payer: Molina Healthcare Passport |
$530.98
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$984.93
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$536.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$757.64
|
|
|
PLEURAL SCARIFICATIN RPT PNTHX
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32215
|
| Hospital Charge Code |
76101182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
PLEUROSCOPY - REMOVE FIBRIN D
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32653
|
| Hospital Charge Code |
76101216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.63 |
| Max. Negotiated Rate |
$1,713.25 |
| Rate for Payer: Aetna Commercial |
$1,713.25
|
| Rate for Payer: Ambetter Exchange |
$998.59
|
| Rate for Payer: Anthem Medicaid |
$690.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$998.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$998.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,198.31
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,586.10
|
| Rate for Payer: Healthspan PPO |
$1,337.66
|
| Rate for Payer: Humana Medicaid |
$690.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,448.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$998.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$704.44
|
| Rate for Payer: Molina Healthcare Passport |
$690.63
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,298.17
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$697.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$998.59
|
|
|
PLEUROSCOPY - REMOVE FIBRIN D
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32653
|
| Hospital Charge Code |
76101216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
PLEUROSCOPY - REMOVE FIBRIN D
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32653
|
| Hospital Charge Code |
76101216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
PLEUROSCOPY - REMOVE FIBRIN (P
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32653
|
| Hospital Charge Code |
761P1216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.63 |
| Max. Negotiated Rate |
$1,713.25 |
| Rate for Payer: Aetna Commercial |
$1,713.25
|
| Rate for Payer: Ambetter Exchange |
$998.59
|
| Rate for Payer: Anthem Medicaid |
$690.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$998.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$998.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,198.31
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,586.10
|
| Rate for Payer: Healthspan PPO |
$1,337.66
|
| Rate for Payer: Humana Medicaid |
$690.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,448.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$998.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$704.44
|
| Rate for Payer: Molina Healthcare Passport |
$690.63
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,298.17
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$697.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$998.59
|
|
|
PLEXA PROMRI S 65
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
PLEXA PROMRI S 65
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
PLMT BILIARY DRAINAGE CATH
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 47534
|
| Hospital Charge Code |
76101958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
PLMT BILIARY DRAINAGE CATH
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 47534
|
| Hospital Charge Code |
76101958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
PLMT BILIARY DRAINAGE CATH
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 47534
|
| Hospital Charge Code |
76101958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.63 |
| Max. Negotiated Rate |
$1,262.06 |
| Rate for Payer: Ambetter Exchange |
$343.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$330.63
|
| Rate for Payer: Anthem Medicaid |
$1,237.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$343.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$343.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$411.90
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$680.46
|
| Rate for Payer: Humana Medicaid |
$1,237.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$574.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$343.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$343.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,262.06
|
| Rate for Payer: Molina Healthcare Passport |
$1,237.31
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$446.23
|
| Rate for Payer: UHCCP Medicaid |
$347.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,249.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$343.25
|
|
|
PLMT BILIARY DRAINAGE CATH(p
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 47534
|
| Hospital Charge Code |
761P1958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.63 |
| Max. Negotiated Rate |
$1,262.06 |
| Rate for Payer: Ambetter Exchange |
$343.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$330.63
|
| Rate for Payer: Anthem Medicaid |
$1,237.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$343.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$343.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$411.90
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$680.46
|
| Rate for Payer: Humana Medicaid |
$1,237.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$574.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$343.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$343.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,262.06
|
| Rate for Payer: Molina Healthcare Passport |
$1,237.31
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$446.23
|
| Rate for Payer: UHCCP Medicaid |
$347.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,249.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$343.25
|
|
|
PLMT NEPHROURETERAL CATHETER
|
Facility
|
IP
|
$6,805.00
|
|
|
Service Code
|
HCPCS 50433
|
| Hospital Charge Code |
76102751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,041.50 |
| Max. Negotiated Rate |
$6,532.80 |
| Rate for Payer: Aetna Commercial |
$5,239.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,307.90
|
| Rate for Payer: Cash Price |
$3,402.50
|
| Rate for Payer: Cigna Commercial |
$5,648.15
|
| Rate for Payer: First Health Commercial |
$6,464.75
|
| Rate for Payer: Humana Commercial |
$5,784.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,580.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,022.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,041.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,988.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,103.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,444.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,920.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,695.45
|
| Rate for Payer: PHCS Commercial |
$6,532.80
|
| Rate for Payer: United Healthcare All Payer |
$5,988.40
|
|
|
PLMT NEPHROURETERAL CATHETER
|
Professional
|
Both
|
$6,805.00
|
|
|
Service Code
|
HCPCS 50433
|
| Hospital Charge Code |
76102751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.81 |
| Max. Negotiated Rate |
$4,083.00 |
| Rate for Payer: Ambetter Exchange |
$236.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.81
|
| Rate for Payer: Anthem Medicaid |
$853.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$236.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$236.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$284.00
|
| Rate for Payer: Cash Price |
$3,402.50
|
| Rate for Payer: Cash Price |
$3,402.50
|
| Rate for Payer: Cigna Commercial |
$455.21
|
| Rate for Payer: Humana Medicaid |
$853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$372.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$236.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$870.24
|
| Rate for Payer: Molina Healthcare Passport |
$853.18
|
| Rate for Payer: Multiplan PHCS |
$4,083.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$307.67
|
| Rate for Payer: UHCCP Medicaid |
$231.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$861.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$236.67
|
|
|
PLMT NEPHROURETERAL CATHETER
|
Facility
|
OP
|
$6,805.00
|
|
|
Service Code
|
HCPCS 50433
|
| Hospital Charge Code |
76102751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,340.24 |
| Max. Negotiated Rate |
$6,532.80 |
| Rate for Payer: Aetna Commercial |
$5,239.85
|
| Rate for Payer: Anthem Medicaid |
$2,340.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,307.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$3,402.50
|
| Rate for Payer: Cash Price |
$3,402.50
|
| Rate for Payer: Cigna Commercial |
$5,648.15
|
| Rate for Payer: First Health Commercial |
$6,464.75
|
| Rate for Payer: Humana Commercial |
$5,784.25
|
| Rate for Payer: Humana KY Medicaid |
$2,340.24
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,364.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,580.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,022.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,387.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,988.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,103.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,444.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,920.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,695.45
|
| Rate for Payer: PHCS Commercial |
$6,532.80
|
| Rate for Payer: United Healthcare All Payer |
$5,988.40
|
|
|
PLMT NEPHROURETERAL CATHETER(P
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 50433
|
| Hospital Charge Code |
761P2751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.81 |
| Max. Negotiated Rate |
$870.24 |
| Rate for Payer: Ambetter Exchange |
$236.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.81
|
| Rate for Payer: Anthem Medicaid |
$853.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$236.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$236.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$284.00
|
| Rate for Payer: Cash Price |
$572.50
|
| Rate for Payer: Cash Price |
$572.50
|
| Rate for Payer: Cigna Commercial |
$455.21
|
| Rate for Payer: Humana Medicaid |
$853.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$372.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$236.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$870.24
|
| Rate for Payer: Molina Healthcare Passport |
$853.18
|
| Rate for Payer: Multiplan PHCS |
$687.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$307.67
|
| Rate for Payer: UHCCP Medicaid |
$231.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$861.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$236.67
|
|
