|
PUSHLOCK 2.9*15.5 AR-1923BC
|
Facility
|
OP
|
$3,670.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.10 |
| Max. Negotiated Rate |
$3,523.20 |
| Rate for Payer: Aetna Commercial |
$2,825.90
|
| Rate for Payer: Anthem Medicaid |
$1,262.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,862.60
|
| Rate for Payer: Cash Price |
$1,835.00
|
| Rate for Payer: Cigna Commercial |
$3,046.10
|
| Rate for Payer: First Health Commercial |
$3,486.50
|
| Rate for Payer: Humana Commercial |
$3,119.50
|
| Rate for Payer: Humana KY Medicaid |
$1,262.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,274.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,009.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,708.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,287.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,752.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$734.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,137.70
|
| Rate for Payer: PHCS Commercial |
$3,523.20
|
| Rate for Payer: United Healthcare All Payer |
$3,229.60
|
|
|
PUSHLOCK 3.5MM*19.5MM
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
PUSHLOCK 3.5MM*19.5MM
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
PUSHLOCK DISP KT F/2.9 AR-1923
|
Facility
|
OP
|
$1,993.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.11 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Aetna Commercial |
$1,534.70
|
| Rate for Payer: Anthem Medicaid |
$685.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,554.63
|
| Rate for Payer: Cash Price |
$996.56
|
| Rate for Payer: Cigna Commercial |
$1,654.29
|
| Rate for Payer: First Health Commercial |
$1,893.46
|
| Rate for Payer: Humana Commercial |
$1,694.15
|
| Rate for Payer: Humana KY Medicaid |
$685.43
|
| Rate for Payer: Kentucky WC Medicaid |
$692.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,634.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,470.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$699.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,753.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,494.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.87
|
| Rate for Payer: PHCS Commercial |
$1,913.40
|
| Rate for Payer: United Healthcare All Payer |
$1,753.95
|
|
|
PUSHLOCK DISP KT F/2.9 AR-1923
|
Facility
|
IP
|
$1,993.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.11 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Aetna Commercial |
$1,534.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,554.63
|
| Rate for Payer: Cash Price |
$996.56
|
| Rate for Payer: Cigna Commercial |
$1,654.29
|
| Rate for Payer: First Health Commercial |
$1,893.46
|
| Rate for Payer: Humana Commercial |
$1,694.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,634.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,470.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,753.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,494.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.87
|
| Rate for Payer: PHCS Commercial |
$1,913.40
|
| Rate for Payer: United Healthcare All Payer |
$1,753.95
|
|
|
PUTTY BEAST 100 INJ 1.0CC
|
Facility
|
IP
|
$4,247.50
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$552.18 |
| Max. Negotiated Rate |
$4,077.60 |
| Rate for Payer: Aetna Commercial |
$3,270.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.05
|
| Rate for Payer: Cash Price |
$2,123.75
|
| Rate for Payer: Cigna Commercial |
$3,525.42
|
| Rate for Payer: First Health Commercial |
$4,035.12
|
| Rate for Payer: Humana Commercial |
$3,610.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,482.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,134.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,737.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,185.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.72
|
| Rate for Payer: PHCS Commercial |
$4,077.60
|
| Rate for Payer: United Healthcare All Payer |
$3,737.80
|
|
|
PUTTY BEAST 100 INJ 1.0CC
|
Facility
|
OP
|
$4,247.50
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$552.18 |
| Max. Negotiated Rate |
$4,077.60 |
| Rate for Payer: Aetna Commercial |
$3,270.58
|
| Rate for Payer: Anthem Medicaid |
$1,460.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,313.05
|
| Rate for Payer: Cash Price |
$2,123.75
|
| Rate for Payer: Cigna Commercial |
$3,525.42
|
| Rate for Payer: First Health Commercial |
$4,035.12
|
| Rate for Payer: Humana Commercial |
$3,610.38
|
| Rate for Payer: Humana KY Medicaid |
$1,460.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,475.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,482.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,134.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,737.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,185.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.72
|
| Rate for Payer: PHCS Commercial |
$4,077.60
|
| Rate for Payer: United Healthcare All Payer |
$3,737.80
|
|
|
PUTTY GRAFTON DBM 10CC
|
Facility
|
OP
|
$5,326.20
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$692.41 |
| Max. Negotiated Rate |
$5,113.15 |
| Rate for Payer: Aetna Commercial |
$4,101.17
|
| Rate for Payer: Anthem Medicaid |
$1,831.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,154.44
|
| Rate for Payer: Cash Price |
$2,663.10
|
| Rate for Payer: Cigna Commercial |
$4,420.75
|
| Rate for Payer: First Health Commercial |
$5,059.89
|
| Rate for Payer: Humana Commercial |
$4,527.27
|
| Rate for Payer: Humana KY Medicaid |
$1,831.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,850.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,367.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,930.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,597.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,868.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,687.06
|
| Rate for Payer: Ohio Health Group HMO |
$3,994.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,065.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,651.12
|
| Rate for Payer: PHCS Commercial |
$5,113.15
|
| Rate for Payer: United Healthcare All Payer |
$4,687.06
|
|
|
PUTTY GRAFTON DBM 10CC
|
Facility
|
IP
|
$5,326.20
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$692.41 |
| Max. Negotiated Rate |
$5,113.15 |
| Rate for Payer: Aetna Commercial |
$4,101.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,154.44
|
| Rate for Payer: Cash Price |
$2,663.10
|
| Rate for Payer: Cigna Commercial |
$4,420.75
|
| Rate for Payer: First Health Commercial |
$5,059.89
|
| Rate for Payer: Humana Commercial |
$4,527.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,367.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,930.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,597.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,687.06
|
| Rate for Payer: Ohio Health Group HMO |
$3,994.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,065.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,651.12
|
| Rate for Payer: PHCS Commercial |
$5,113.15
|
| Rate for Payer: United Healthcare All Payer |
$4,687.06
|
|
|
PUTTY GRAFTON DBM 5CC
|
Facility
|
OP
|
$4,281.90
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$556.65 |
| Max. Negotiated Rate |
$4,110.62 |
| Rate for Payer: Aetna Commercial |
$3,297.06
|
| Rate for Payer: Anthem Medicaid |
$1,472.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,339.88
|
| Rate for Payer: Cash Price |
$2,140.95
|
| Rate for Payer: Cigna Commercial |
$3,553.98
|
| Rate for Payer: First Health Commercial |
$4,067.80
|
| Rate for Payer: Humana Commercial |
$3,639.62
|
| Rate for Payer: Humana KY Medicaid |
$1,472.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,487.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,511.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,160.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,502.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,768.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,211.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.39
|
| Rate for Payer: PHCS Commercial |
$4,110.62
|
| Rate for Payer: United Healthcare All Payer |
$3,768.07
|
|
|
PUTTY GRAFTON DBM 5CC
|
Facility
|
IP
|
$4,281.90
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$556.65 |
| Max. Negotiated Rate |
$4,110.62 |
| Rate for Payer: Aetna Commercial |
$3,297.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,339.88
|
| Rate for Payer: Cash Price |
$2,140.95
|
| Rate for Payer: Cigna Commercial |
$3,553.98
|
| Rate for Payer: First Health Commercial |
$4,067.80
|
| Rate for Payer: Humana Commercial |
$3,639.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,511.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,160.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,768.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,211.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.39
|
| Rate for Payer: PHCS Commercial |
$4,110.62
|
| Rate for Payer: United Healthcare All Payer |
$3,768.07
|
|
|
PUTTY INJECT ALLOMATRIX 5CC
|
Facility
|
OP
|
$5,420.00
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.60 |
| Max. Negotiated Rate |
$5,203.20 |
| Rate for Payer: Aetna Commercial |
$4,173.40
|
| Rate for Payer: Anthem Medicaid |
$1,863.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,227.60
|
| Rate for Payer: Cash Price |
$2,710.00
|
| Rate for Payer: Cigna Commercial |
$4,498.60
|
| Rate for Payer: First Health Commercial |
$5,149.00
|
| Rate for Payer: Humana Commercial |
$4,607.00
|
| Rate for Payer: Humana KY Medicaid |
$1,863.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,882.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,444.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,999.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,626.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,901.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,769.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,065.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,084.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,680.20
|
| Rate for Payer: PHCS Commercial |
$5,203.20
|
| Rate for Payer: United Healthcare All Payer |
$4,769.60
|
|
|
PUTTY INJECT ALLOMATRIX 5CC
|
Facility
|
IP
|
$5,420.00
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.60 |
| Max. Negotiated Rate |
$5,203.20 |
| Rate for Payer: Aetna Commercial |
$4,173.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,227.60
|
| Rate for Payer: Cash Price |
$2,710.00
|
| Rate for Payer: Cigna Commercial |
$4,498.60
|
| Rate for Payer: First Health Commercial |
$5,149.00
|
| Rate for Payer: Humana Commercial |
$4,607.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,444.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,999.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,626.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,769.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,065.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,084.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,680.20
|
| Rate for Payer: PHCS Commercial |
$5,203.20
|
| Rate for Payer: United Healthcare All Payer |
$4,769.60
|
|
|
PX IMP NSM ELTRD SAC NRVE WIMG
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64561
|
| Hospital Charge Code |
761P2336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.17 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$690.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$154.17
|
| Rate for Payer: Anthem Medicaid |
$295.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$597.48
|
| Rate for Payer: Healthspan PPO |
$1,369.62
|
| Rate for Payer: Humana Medicaid |
$295.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$524.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.50
|
| Rate for Payer: Molina Healthcare Passport |
$295.59
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$161.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$298.55
|
|
|
PX IMP NSM ELTRD SAC NRVE WIMG
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64561
|
| Hospital Charge Code |
76102336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$8,279.85 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,914.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,279.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,984.14
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$5,914.18
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,097.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
PX IMP NSM ELTRD SAC NRVE WIMG
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64561
|
| Hospital Charge Code |
76102336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.17 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$690.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$154.17
|
| Rate for Payer: Anthem Medicaid |
$295.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$597.48
|
| Rate for Payer: Healthspan PPO |
$1,369.62
|
| Rate for Payer: Humana Medicaid |
$295.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$524.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$301.50
|
| Rate for Payer: Molina Healthcare Passport |
$295.59
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$161.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$298.55
|
|
|
PX IMP NSM ELTRD SAC NRVE WIMG
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64561
|
| Hospital Charge Code |
76102336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
PX SLIM DEL. MICROCATHETER
|
Facility
|
OP
|
$5,294.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$688.22 |
| Max. Negotiated Rate |
$5,082.24 |
| Rate for Payer: Aetna Commercial |
$4,076.38
|
| Rate for Payer: Anthem Medicaid |
$1,820.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,129.32
|
| Rate for Payer: Cash Price |
$2,647.00
|
| Rate for Payer: Cigna Commercial |
$4,394.02
|
| Rate for Payer: First Health Commercial |
$5,029.30
|
| Rate for Payer: Humana Commercial |
$4,499.90
|
| Rate for Payer: Humana KY Medicaid |
$1,820.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,839.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,341.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,906.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,588.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,857.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,658.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,058.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$688.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,641.14
|
| Rate for Payer: PHCS Commercial |
$5,082.24
|
| Rate for Payer: United Healthcare All Payer |
$4,658.72
|
|
|
PX SLIM DEL. MICROCATHETER
|
Facility
|
IP
|
$5,294.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$688.22 |
| Max. Negotiated Rate |
$5,082.24 |
| Rate for Payer: Aetna Commercial |
$4,076.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,129.32
|
| Rate for Payer: Cash Price |
$2,647.00
|
| Rate for Payer: Cigna Commercial |
$4,394.02
|
| Rate for Payer: First Health Commercial |
$5,029.30
|
| Rate for Payer: Humana Commercial |
$4,499.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,341.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,906.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,588.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,658.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,058.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$688.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,641.14
|
| Rate for Payer: PHCS Commercial |
$5,082.24
|
| Rate for Payer: United Healthcare All Payer |
$4,658.72
|
|
|
PYELOTOMY; WITH DRAINAGE - P(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 50125
|
| Hospital Charge Code |
761P2044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$777.51 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,605.75
|
| Rate for Payer: Anthem Medicaid |
$777.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,444.32
|
| Rate for Payer: Healthspan PPO |
$1,283.94
|
| Rate for Payer: Humana Medicaid |
$777.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,368.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$793.06
|
| Rate for Payer: Molina Healthcare Passport |
$777.51
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$785.29
|
|
|
PYELOTOMY; WITH DRAINAGE - PY
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 50125
|
| Hospital Charge Code |
76102044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| 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 |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
PYELOTOMY; WITH DRAINAGE - PY
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 50125
|
| Hospital Charge Code |
76102044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$777.51 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,605.75
|
| Rate for Payer: Anthem Medicaid |
$777.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,444.32
|
| Rate for Payer: Healthspan PPO |
$1,283.94
|
| Rate for Payer: Humana Medicaid |
$777.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,368.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$793.06
|
| Rate for Payer: Molina Healthcare Passport |
$777.51
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$785.29
|
|
|
PYELOTOMY; WITH DRAINAGE - PY
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 50125
|
| Hospital Charge Code |
76102044
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| 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 |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
PYLOROMYOTOMY - CUTTING OF P(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 43520
|
| Hospital Charge Code |
761P1782
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.71 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,015.85
|
| Rate for Payer: Anthem Medicaid |
$346.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$956.19
|
| Rate for Payer: Healthspan PPO |
$856.68
|
| Rate for Payer: Humana Medicaid |
$346.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$894.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.64
|
| Rate for Payer: Molina Healthcare Passport |
$346.71
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.18
|
|
|
PYLOROMYOTOMY - CUTTING OF PY
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 43520
|
| Hospital Charge Code |
76101782
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
