|
PUTTY BEAST 100 INJ 1.0CC
|
Facility
|
OP
|
$4,193.75
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,258.12 |
| Max. Negotiated Rate |
$4,026.00 |
| Rate for Payer: Aetna Commercial |
$3,229.19
|
| Rate for Payer: Anthem Medicaid |
$1,442.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,271.12
|
| Rate for Payer: Cash Price |
$2,096.88
|
| Rate for Payer: Cigna Commercial |
$3,480.81
|
| Rate for Payer: First Health Commercial |
$3,984.06
|
| Rate for Payer: Humana Commercial |
$3,564.69
|
| Rate for Payer: Humana KY Medicaid |
$1,442.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,456.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,438.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,094.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,471.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,690.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,145.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,355.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,648.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.69
|
| Rate for Payer: PHCS Commercial |
$4,026.00
|
| Rate for Payer: United Healthcare All Payer |
$3,690.50
|
|
|
PUTTY BEAST 100 INJ 1.0CC
|
Facility
|
IP
|
$4,193.75
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,258.12 |
| Max. Negotiated Rate |
$4,026.00 |
| Rate for Payer: Aetna Commercial |
$3,229.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,271.12
|
| Rate for Payer: Cash Price |
$2,096.88
|
| Rate for Payer: Cigna Commercial |
$3,480.81
|
| Rate for Payer: First Health Commercial |
$3,984.06
|
| Rate for Payer: Humana Commercial |
$3,564.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,438.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,094.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,690.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,145.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,355.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,648.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,893.69
|
| Rate for Payer: PHCS Commercial |
$4,026.00
|
| Rate for Payer: United Healthcare All Payer |
$3,690.50
|
|
|
PUTTY GRAFTON DBM 10CC
|
Facility
|
OP
|
$5,349.50
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,604.85 |
| Max. Negotiated Rate |
$5,135.52 |
| Rate for Payer: Aetna Commercial |
$4,119.11
|
| Rate for Payer: Anthem Medicaid |
$1,839.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,172.61
|
| Rate for Payer: Cash Price |
$2,674.75
|
| Rate for Payer: Cigna Commercial |
$4,440.09
|
| Rate for Payer: First Health Commercial |
$5,082.02
|
| Rate for Payer: Humana Commercial |
$4,547.07
|
| Rate for Payer: Humana KY Medicaid |
$1,839.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,386.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,947.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,604.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,707.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,279.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,654.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,691.16
|
| Rate for Payer: PHCS Commercial |
$5,135.52
|
| Rate for Payer: United Healthcare All Payer |
$4,707.56
|
|
|
PUTTY GRAFTON DBM 10CC
|
Facility
|
IP
|
$5,349.50
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,604.85 |
| Max. Negotiated Rate |
$5,135.52 |
| Rate for Payer: Aetna Commercial |
$4,119.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,172.61
|
| Rate for Payer: Cash Price |
$2,674.75
|
| Rate for Payer: Cigna Commercial |
$4,440.09
|
| Rate for Payer: First Health Commercial |
$5,082.02
|
| Rate for Payer: Humana Commercial |
$4,547.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,386.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,947.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,604.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,707.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,279.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,654.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,691.16
|
| Rate for Payer: PHCS Commercial |
$5,135.52
|
| Rate for Payer: United Healthcare All Payer |
$4,707.56
|
|
|
PUTTY GRAFTON DBM 5CC
|
Facility
|
OP
|
$4,230.61
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,269.18 |
| Max. Negotiated Rate |
$4,061.39 |
| Rate for Payer: Aetna Commercial |
$3,257.57
|
| Rate for Payer: Anthem Medicaid |
$1,454.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,299.88
|
| Rate for Payer: Cash Price |
$2,115.31
|
| Rate for Payer: Cigna Commercial |
$3,511.41
|
| Rate for Payer: First Health Commercial |
$4,019.08
|
| Rate for Payer: Humana Commercial |
$3,596.02
|
| Rate for Payer: Humana KY Medicaid |
$1,454.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,469.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,469.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,122.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,484.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,722.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,172.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,384.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,680.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,919.12
|
| Rate for Payer: PHCS Commercial |
$4,061.39
|
| Rate for Payer: United Healthcare All Payer |
$3,722.94
|
|
|
PUTTY GRAFTON DBM 5CC
|
Facility
|
IP
|
$4,230.61
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,269.18 |
| Max. Negotiated Rate |
$4,061.39 |
| Rate for Payer: Aetna Commercial |
$3,257.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,299.88
|
| Rate for Payer: Cash Price |
$2,115.31
|
| Rate for Payer: Cigna Commercial |
$3,511.41
|
| Rate for Payer: First Health Commercial |
$4,019.08
|
| Rate for Payer: Humana Commercial |
$3,596.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,469.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,122.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,722.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,172.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,384.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,680.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,919.12
|
| Rate for Payer: PHCS Commercial |
$4,061.39
|
| Rate for Payer: United Healthcare All Payer |
$3,722.94
|
|
|
PUTTY INJECT ALLOMATRIX 5CC
|
Facility
|
OP
|
$5,450.00
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,635.00 |
| Max. Negotiated Rate |
$5,232.00 |
| Rate for Payer: Aetna Commercial |
$4,196.50
|
| Rate for Payer: Anthem Medicaid |
$1,874.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,251.00
|
| Rate for Payer: Cash Price |
$2,725.00
|
| Rate for Payer: Cigna Commercial |
$4,523.50
|
| Rate for Payer: First Health Commercial |
$5,177.50
|
| Rate for Payer: Humana Commercial |
$4,632.50
|
| Rate for Payer: Humana KY Medicaid |
$1,874.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,893.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,469.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,022.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,635.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,911.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,796.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,741.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,760.50
|
| Rate for Payer: PHCS Commercial |
$5,232.00
|
| Rate for Payer: United Healthcare All Payer |
$4,796.00
|
|
|
PUTTY INJECT ALLOMATRIX 5CC
|
Facility
|
IP
|
$5,450.00
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
27000053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,635.00 |
| Max. Negotiated Rate |
$5,232.00 |
| Rate for Payer: Aetna Commercial |
$4,196.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,251.00
|
| Rate for Payer: Cash Price |
$2,725.00
|
| Rate for Payer: Cigna Commercial |
$4,523.50
|
| Rate for Payer: First Health Commercial |
$5,177.50
|
| Rate for Payer: Humana Commercial |
$4,632.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,469.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,022.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,635.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,796.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,741.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,760.50
|
| Rate for Payer: PHCS Commercial |
$5,232.00
|
| Rate for Payer: United Healthcare All Payer |
$4,796.00
|
|
|
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 |
$481.46 |
| Max. Negotiated Rate |
$8,489.59 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,063.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,489.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,186.39
|
| 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 |
$6,063.99
|
| 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 |
$7,276.79
|
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| 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
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64561
|
| Hospital Charge Code |
76102336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| 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 |
$1,369.62 |
| Rate for Payer: Aetna Commercial |
$690.50
|
| Rate for Payer: Ambetter Exchange |
$286.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$154.17
|
| Rate for Payer: Anthem Medicaid |
$591.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$286.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$286.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$343.63
|
| 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 |
$591.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$524.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$286.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$602.97
|
| Rate for Payer: Molina Healthcare Passport |
$591.15
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$372.27
|
| Rate for Payer: UHCCP Medicaid |
$161.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$286.36
|
|
|
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 |
$1,369.62 |
| Rate for Payer: Aetna Commercial |
$690.50
|
| Rate for Payer: Ambetter Exchange |
$286.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$154.17
|
| Rate for Payer: Anthem Medicaid |
$591.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$286.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$286.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$343.63
|
| 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 |
$591.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$524.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$286.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$602.97
|
| Rate for Payer: Molina Healthcare Passport |
$591.15
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$372.27
|
| Rate for Payer: UHCCP Medicaid |
$161.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$286.36
|
|
|
PX SLIM DEL. MICROCATHETER
|
Facility
|
OP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,594.50 |
| Max. Negotiated Rate |
$5,102.40 |
| Rate for Payer: Aetna Commercial |
$4,092.55
|
| Rate for Payer: Anthem Medicaid |
$1,827.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,145.70
|
| Rate for Payer: Cash Price |
$2,657.50
|
| Rate for Payer: Cigna Commercial |
$4,411.45
|
| Rate for Payer: First Health Commercial |
$5,049.25
|
| Rate for Payer: Humana Commercial |
$4,517.75
|
| Rate for Payer: Humana KY Medicaid |
$1,827.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,846.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,358.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,922.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,594.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,864.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,677.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,986.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,624.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,667.35
|
| Rate for Payer: PHCS Commercial |
$5,102.40
|
| Rate for Payer: United Healthcare All Payer |
$4,677.20
|
|
|
PX SLIM DEL. MICROCATHETER
|
Facility
|
IP
|
$5,315.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,594.50 |
| Max. Negotiated Rate |
$5,102.40 |
| Rate for Payer: Aetna Commercial |
$4,092.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,145.70
|
| Rate for Payer: Cash Price |
$2,657.50
|
| Rate for Payer: Cigna Commercial |
$4,411.45
|
| Rate for Payer: First Health Commercial |
$5,049.25
|
| Rate for Payer: Humana Commercial |
$4,517.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,358.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,922.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,594.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,677.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,986.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,624.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,667.35
|
| Rate for Payer: PHCS Commercial |
$5,102.40
|
| Rate for Payer: United Healthcare All Payer |
$4,677.20
|
|
|
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 |
$1,605.75 |
| Rate for Payer: Aetna Commercial |
$1,605.75
|
| Rate for Payer: Ambetter Exchange |
$927.57
|
| Rate for Payer: Anthem Medicaid |
$777.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$927.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$927.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,113.08
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$927.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$927.57
|
| 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 |
$1,205.84
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$785.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$927.57
|
|
|
PYELOTOMY; WITH DRAINAGE - PY
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 50125
|
| Hospital Charge Code |
76102044
|
|
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
|
|
|
PYELOTOMY; WITH DRAINAGE - PY
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 50125
|
| Hospital Charge Code |
76102044
|
|
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
|
|
|
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 |
$1,605.75 |
| Rate for Payer: Aetna Commercial |
$1,605.75
|
| Rate for Payer: Ambetter Exchange |
$927.57
|
| Rate for Payer: Anthem Medicaid |
$777.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$927.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$927.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,113.08
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$927.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$927.57
|
| 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 |
$1,205.84
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$785.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$927.57
|
|
|
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 |
$1,015.85 |
| Rate for Payer: Aetna Commercial |
$1,015.85
|
| Rate for Payer: Ambetter Exchange |
$681.29
|
| Rate for Payer: Anthem Medicaid |
$346.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$681.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$681.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$817.55
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$681.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$681.29
|
| 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 |
$885.68
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$681.29
|
|
|
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 |
$1,015.85 |
| Rate for Payer: Aetna Commercial |
$1,015.85
|
| Rate for Payer: Ambetter Exchange |
$681.29
|
| Rate for Payer: Anthem Medicaid |
$346.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$681.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$681.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$817.55
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$681.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$681.29
|
| 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 |
$885.68
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$681.29
|
|
|
PYLOROMYOTOMY - CUTTING OF PY
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 43520
|
| Hospital Charge Code |
76101782
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
PYLOROMYOTOMY - CUTTING OF PY
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 43520
|
| Hospital Charge Code |
76101782
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
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: Ambetter Exchange |
$887.28
|
| Rate for Payer: Anthem Medicaid |
$495.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$887.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$887.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.74
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$887.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.28
|
| 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 |
$1,153.46
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$500.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$887.28
|
|
|
PYLOROPLASTY
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 43800
|
| Hospital Charge Code |
76101796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.50 |
| 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 |
$996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,083.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.05
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
PYLOROPLASTY
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 43800
|
| Hospital Charge Code |
76101796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.50 |
| 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 |
$996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,083.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.05
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
