|
PYLOROMYOTOMY - CUTTING OF PY
|
Facility
|
OP
|
$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 Medicaid |
$515.85
|
| 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: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| 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: Molina Healthcare Medicaid |
$526.20
|
| 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
|
|
|
PYLOROMYOTOMY - CUTTING OF PY
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 43520
|
| Hospital Charge Code |
76101782
|
|
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
|
|
|
PYLOROPLASTY
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 43800
|
| Hospital Charge Code |
76101796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.85 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Anthem Medicaid |
$428.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.10
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,033.35
|
| Rate for Payer: First Health Commercial |
$1,182.75
|
| Rate for Payer: Humana Commercial |
$1,058.25
|
| Rate for Payer: Humana KY Medicaid |
$428.16
|
| Rate for Payer: Kentucky WC Medicaid |
$432.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,020.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$918.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$436.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,095.60
|
| Rate for Payer: Ohio Health Group HMO |
$933.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$249.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.95
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
PYLOROPLASTY
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 43800
|
| Hospital Charge Code |
76101796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.75 |
| Max. Negotiated Rate |
$1,338.97 |
| Rate for Payer: Aetna Commercial |
$1,338.97
|
| Rate for Payer: Anthem Medicaid |
$495.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,245.00
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,243.29
|
| Rate for Payer: Healthspan PPO |
$1,129.18
|
| Rate for Payer: Humana Medicaid |
$495.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,187.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$505.48
|
| Rate for Payer: Molina Healthcare Passport |
$495.57
|
| Rate for Payer: Multiplan PHCS |
$747.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$871.50
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$500.53
|
|
|
PYLOROPLASTY
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 43800
|
| Hospital Charge Code |
76101796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.85 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.10
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,033.35
|
| Rate for Payer: First Health Commercial |
$1,182.75
|
| Rate for Payer: Humana Commercial |
$1,058.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,020.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$918.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,095.60
|
| Rate for Payer: Ohio Health Group HMO |
$933.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$249.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.95
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
PYLOROPLASTY(P
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 43800
|
| Hospital Charge Code |
761P1796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.75 |
| Max. Negotiated Rate |
$1,338.97 |
| Rate for Payer: Aetna Commercial |
$1,338.97
|
| Rate for Payer: Anthem Medicaid |
$495.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,245.00
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,243.29
|
| Rate for Payer: Healthspan PPO |
$1,129.18
|
| Rate for Payer: Humana Medicaid |
$495.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,187.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$505.48
|
| Rate for Payer: Molina Healthcare Passport |
$495.57
|
| Rate for Payer: Multiplan PHCS |
$747.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$871.50
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$500.53
|
|
|
PYRAZINAMIDE 500 MG 500MG/1TAB
|
Facility
|
OP
|
$12.43
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
25001278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$11.93 |
| Rate for Payer: Humana Commercial |
$10.57
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.94
|
| Rate for Payer: Ohio Health Group HMO |
$9.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.85
|
| Rate for Payer: PHCS Commercial |
$11.93
|
| Rate for Payer: United Healthcare All Payer |
$10.94
|
| Rate for Payer: Aetna Commercial |
$9.57
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.70
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cigna Commercial |
$10.32
|
| Rate for Payer: First Health Commercial |
$11.81
|
|
|
PYRAZINAMIDE 500 MG 500MG/1TAB
|
Facility
|
IP
|
$12.43
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
25001278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$11.93 |
| Rate for Payer: Aetna Commercial |
$9.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.70
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cigna Commercial |
$10.32
|
| Rate for Payer: First Health Commercial |
$11.81
|
| Rate for Payer: Humana Commercial |
$10.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.94
|
| Rate for Payer: Ohio Health Group HMO |
$9.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.85
|
| Rate for Payer: PHCS Commercial |
$11.93
|
| Rate for Payer: United Healthcare All Payer |
$10.94
|
|
|
PYRIDIUM(PHENAZOPYR 100MG/1TAB
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 65162068110
|
| Hospital Charge Code |
25001279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
PYRIDIUM(PHENAZOPYR 100MG/1TAB
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 65162068110
|
| Hospital Charge Code |
25001279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
PYRIDOXINE 100 MG INJECTION
|
Facility
|
IP
|
$126.06
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
25002425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$121.02 |
| Rate for Payer: Aetna Commercial |
$97.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.33
|
| Rate for Payer: Cash Price |
$63.03
|
| Rate for Payer: Cigna Commercial |
$104.63
|
| Rate for Payer: First Health Commercial |
$119.76
|
| Rate for Payer: Humana Commercial |
$107.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.93
|
| Rate for Payer: Ohio Health Group HMO |
$94.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.08
|
| Rate for Payer: PHCS Commercial |
$121.02
|
| Rate for Payer: United Healthcare All Payer |
$110.93
|
|
|
PYRIDOXINE 100 MG INJECTION
|
Facility
|
OP
|
$126.06
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
25002425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$121.02 |
| Rate for Payer: Aetna Commercial |
$97.07
|
| Rate for Payer: Anthem Medicaid |
$43.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.33
|
| Rate for Payer: Cash Price |
$63.03
|
| Rate for Payer: Cigna Commercial |
$104.63
|
| Rate for Payer: First Health Commercial |
$119.76
|
| Rate for Payer: Humana Commercial |
$107.15
|
| Rate for Payer: Humana KY Medicaid |
$43.35
|
| Rate for Payer: Kentucky WC Medicaid |
$43.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.93
|
| Rate for Payer: Ohio Health Group HMO |
$94.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.08
|
| Rate for Payer: PHCS Commercial |
$121.02
|
| Rate for Payer: United Healthcare All Payer |
$110.93
|
|
|
PYRIDOXINE 100 MG T 100MG/1TAB
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 50268085915
|
| Hospital Charge Code |
25001280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
PYRIDOXINE 100 MG T 100MG/1TAB
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 50268085915
|
| Hospital Charge Code |
25001280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
QUAD HARVESTER 10MM
|
Facility
|
IP
|
$3,761.88
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$489.04 |
| Max. Negotiated Rate |
$3,611.40 |
| Rate for Payer: Aetna Commercial |
$2,896.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,934.27
|
| Rate for Payer: Cash Price |
$1,880.94
|
| Rate for Payer: Cigna Commercial |
$3,122.36
|
| Rate for Payer: First Health Commercial |
$3,573.79
|
| Rate for Payer: Humana Commercial |
$3,197.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,084.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,776.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,310.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,821.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.18
|
| Rate for Payer: PHCS Commercial |
$3,611.40
|
| Rate for Payer: United Healthcare All Payer |
$3,310.45
|
|
|
QUAD HARVESTER 10MM
|
Facility
|
OP
|
$3,761.88
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$489.04 |
| Max. Negotiated Rate |
$3,611.40 |
| Rate for Payer: Aetna Commercial |
$2,896.65
|
| Rate for Payer: Anthem Medicaid |
$1,293.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,934.27
|
| Rate for Payer: Cash Price |
$1,880.94
|
| Rate for Payer: Cigna Commercial |
$3,122.36
|
| Rate for Payer: First Health Commercial |
$3,573.79
|
| Rate for Payer: Humana Commercial |
$3,197.60
|
| Rate for Payer: Humana KY Medicaid |
$1,293.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,306.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,084.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,776.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,319.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,310.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,821.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.18
|
| Rate for Payer: PHCS Commercial |
$3,611.40
|
| Rate for Payer: United Healthcare All Payer |
$3,310.45
|
|
|
QUAD HARVESTER 11MM
|
Facility
|
OP
|
$3,687.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.38 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem Medicaid |
$1,268.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.12
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
QUAD HARVESTER 11MM
|
Facility
|
IP
|
$3,687.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.38 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.12
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
QUAD HARVESTER 9MM
|
Facility
|
OP
|
$3,761.88
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$489.04 |
| Max. Negotiated Rate |
$3,611.40 |
| Rate for Payer: Aetna Commercial |
$2,896.65
|
| Rate for Payer: Anthem Medicaid |
$1,293.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,934.27
|
| Rate for Payer: Cash Price |
$1,880.94
|
| Rate for Payer: Cigna Commercial |
$3,122.36
|
| Rate for Payer: First Health Commercial |
$3,573.79
|
| Rate for Payer: Humana Commercial |
$3,197.60
|
| Rate for Payer: Humana KY Medicaid |
$1,293.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,306.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,084.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,776.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,319.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,310.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,821.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.18
|
| Rate for Payer: PHCS Commercial |
$3,611.40
|
| Rate for Payer: United Healthcare All Payer |
$3,310.45
|
|
|
QUAD HARVESTER 9MM
|
Facility
|
IP
|
$3,761.88
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$489.04 |
| Max. Negotiated Rate |
$3,611.40 |
| Rate for Payer: Aetna Commercial |
$2,896.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,934.27
|
| Rate for Payer: Cash Price |
$1,880.94
|
| Rate for Payer: Cigna Commercial |
$3,122.36
|
| Rate for Payer: First Health Commercial |
$3,573.79
|
| Rate for Payer: Humana Commercial |
$3,197.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,084.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,776.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,310.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,821.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.18
|
| Rate for Payer: PHCS Commercial |
$3,611.40
|
| Rate for Payer: United Healthcare All Payer |
$3,310.45
|
|
|
QUADRA ASSURA MP ICD UMRI
|
Facility
|
OP
|
$73,466.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,550.68 |
| Max. Negotiated Rate |
$70,528.13 |
| Rate for Payer: Aetna Commercial |
$56,569.44
|
| Rate for Payer: Anthem Medicaid |
$25,265.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,304.10
|
| Rate for Payer: Cash Price |
$36,733.40
|
| Rate for Payer: Cigna Commercial |
$60,977.44
|
| Rate for Payer: First Health Commercial |
$69,793.46
|
| Rate for Payer: Humana Commercial |
$62,446.78
|
| Rate for Payer: Humana KY Medicaid |
$25,265.23
|
| Rate for Payer: Kentucky WC Medicaid |
$25,522.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,242.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,218.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,040.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,772.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,650.78
|
| Rate for Payer: Ohio Health Group HMO |
$55,100.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,693.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,550.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,774.71
|
| Rate for Payer: PHCS Commercial |
$70,528.13
|
| Rate for Payer: United Healthcare All Payer |
$64,650.78
|
|
|
QUADRA ASSURA MP ICD UMRI
|
Facility
|
IP
|
$73,466.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,550.68 |
| Max. Negotiated Rate |
$70,528.13 |
| Rate for Payer: Aetna Commercial |
$56,569.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,304.10
|
| Rate for Payer: Cash Price |
$36,733.40
|
| Rate for Payer: Cigna Commercial |
$60,977.44
|
| Rate for Payer: First Health Commercial |
$69,793.46
|
| Rate for Payer: Humana Commercial |
$62,446.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,242.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,218.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,040.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,650.78
|
| Rate for Payer: Ohio Health Group HMO |
$55,100.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,693.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,550.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,774.71
|
| Rate for Payer: PHCS Commercial |
$70,528.13
|
| Rate for Payer: United Healthcare All Payer |
$64,650.78
|
|
|
QUADRICEPSPLASTY
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 27430
|
| Hospital Charge Code |
76102700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$1,193.43 |
| Rate for Payer: Aetna Commercial |
$1,090.77
|
| Rate for Payer: Anthem Medicaid |
$549.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$1,193.43
|
| Rate for Payer: Healthspan PPO |
$988.00
|
| Rate for Payer: Humana Medicaid |
$549.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$917.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$560.24
|
| Rate for Payer: Molina Healthcare Passport |
$549.25
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$554.74
|
|
|
QUANTIFERON TB GOLD
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 86481
|
| Hospital Charge Code |
30001102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$180.48 |
| Rate for Payer: Aetna Commercial |
$144.76
|
| Rate for Payer: Anthem Medicaid |
$100.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$100.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$140.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$156.04
|
| Rate for Payer: First Health Commercial |
$178.60
|
| Rate for Payer: Humana Commercial |
$159.80
|
| Rate for Payer: Humana KY Medicaid |
$100.00
|
| Rate for Payer: Humana Medicare Advantage |
$100.00
|
| Rate for Payer: Kentucky WC Medicaid |
$101.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.44
|
| Rate for Payer: Ohio Health Group HMO |
$141.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.28
|
| Rate for Payer: PHCS Commercial |
$180.48
|
| Rate for Payer: United Healthcare All Payer |
$165.44
|
|
|
QUANTIFERON TB GOLD
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 86481
|
| Hospital Charge Code |
30001102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$180.48 |
| Rate for Payer: Aetna Commercial |
$144.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.96
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$156.04
|
| Rate for Payer: First Health Commercial |
$178.60
|
| Rate for Payer: Humana Commercial |
$159.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.44
|
| Rate for Payer: Ohio Health Group HMO |
$141.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.28
|
| Rate for Payer: PHCS Commercial |
$180.48
|
| Rate for Payer: United Healthcare All Payer |
$165.44
|
|
