|
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: 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
|
|
|
PYRAZINAMIDE 500 MG 500MG/1TAB
|
Facility
|
OP
|
$12.43
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
25001278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$11.93 |
| 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
|
| 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 |
$9.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.58
|
| Rate for Payer: PHCS Commercial |
$11.93
|
| Rate for Payer: United Healthcare All Payer |
$10.94
|
|
|
PYRAZINAMIDE 500 MG 500MG/1TAB
|
Facility
|
IP
|
$12.43
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
25001278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.73 |
| 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 |
$9.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.58
|
| Rate for Payer: PHCS Commercial |
$11.93
|
| Rate for Payer: United Healthcare All Payer |
$10.94
|
|
|
PYRIDIUM(PHENAZOPYR 100MG/1TAB
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 65162068110
|
| Hospital Charge Code |
25001279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| 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 |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
PYRIDIUM(PHENAZOPYR 100MG/1TAB
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 65162068110
|
| Hospital Charge Code |
25001279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| 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 |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
PYRIDOXINE 100 MG INJECTION
|
Facility
|
OP
|
$126.06
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
25002425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.82 |
| 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 |
$94.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.98
|
| Rate for Payer: PHCS Commercial |
$121.02
|
| Rate for Payer: United Healthcare All Payer |
$110.93
|
|
|
PYRIDOXINE 100 MG INJECTION
|
Facility
|
IP
|
$126.06
|
|
|
Service Code
|
HCPCS J3415
|
| Hospital Charge Code |
25002425
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.82 |
| 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 |
$94.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.98
|
| Rate for Payer: PHCS Commercial |
$121.02
|
| Rate for Payer: United Healthcare All Payer |
$110.93
|
|
|
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 |
$1.33 |
| 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 |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
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 |
$1.33 |
| 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 |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
QUAD HARVESTER 10MM
|
Facility
|
OP
|
$3,673.44
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,102.03 |
| Max. Negotiated Rate |
$3,526.50 |
| Rate for Payer: Aetna Commercial |
$2,828.55
|
| Rate for Payer: Anthem Medicaid |
$1,263.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,865.28
|
| Rate for Payer: Cash Price |
$1,836.72
|
| Rate for Payer: Cigna Commercial |
$3,048.96
|
| Rate for Payer: First Health Commercial |
$3,489.77
|
| Rate for Payer: Humana Commercial |
$3,122.42
|
| Rate for Payer: Humana KY Medicaid |
$1,263.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,276.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,012.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,711.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,288.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,232.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,755.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,938.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,195.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,534.67
|
| Rate for Payer: PHCS Commercial |
$3,526.50
|
| Rate for Payer: United Healthcare All Payer |
$3,232.63
|
|
|
QUAD HARVESTER 10MM
|
Facility
|
IP
|
$3,673.44
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,102.03 |
| Max. Negotiated Rate |
$3,526.50 |
| Rate for Payer: Aetna Commercial |
$2,828.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,865.28
|
| Rate for Payer: Cash Price |
$1,836.72
|
| Rate for Payer: Cigna Commercial |
$3,048.96
|
| Rate for Payer: First Health Commercial |
$3,489.77
|
| Rate for Payer: Humana Commercial |
$3,122.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,012.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,711.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,232.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,755.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,938.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,195.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,534.67
|
| Rate for Payer: PHCS Commercial |
$3,526.50
|
| Rate for Payer: United Healthcare All Payer |
$3,232.63
|
|
|
QUAD HARVESTER 11MM
|
Facility
|
IP
|
$3,593.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,078.12 |
| Max. Negotiated Rate |
$3,450.00 |
| Rate for Payer: Aetna Commercial |
$2,767.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,803.12
|
| Rate for Payer: Cash Price |
$1,796.88
|
| Rate for Payer: Cigna Commercial |
$2,982.81
|
| Rate for Payer: First Health Commercial |
$3,414.06
|
| Rate for Payer: Humana Commercial |
$3,054.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,946.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,652.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,162.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,695.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,875.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,126.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,479.69
|
| Rate for Payer: PHCS Commercial |
$3,450.00
|
| Rate for Payer: United Healthcare All Payer |
$3,162.50
|
|
|
QUAD HARVESTER 11MM
|
Facility
|
OP
|
$3,593.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,078.12 |
| Max. Negotiated Rate |
$3,450.00 |
| Rate for Payer: Aetna Commercial |
$2,767.19
|
| Rate for Payer: Anthem Medicaid |
$1,235.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,803.12
|
| Rate for Payer: Cash Price |
$1,796.88
|
| Rate for Payer: Cigna Commercial |
$2,982.81
|
| Rate for Payer: First Health Commercial |
$3,414.06
|
| Rate for Payer: Humana Commercial |
$3,054.69
|
| Rate for Payer: Humana KY Medicaid |
$1,235.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,248.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,946.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,652.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,260.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,162.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,695.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,875.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,126.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,479.69
|
| Rate for Payer: PHCS Commercial |
$3,450.00
|
| Rate for Payer: United Healthcare All Payer |
$3,162.50
|
|
|
QUAD HARVESTER 9MM
|
Facility
|
IP
|
$3,673.44
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,102.03 |
| Max. Negotiated Rate |
$3,526.50 |
| Rate for Payer: Aetna Commercial |
$2,828.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,865.28
|
| Rate for Payer: Cash Price |
$1,836.72
|
| Rate for Payer: Cigna Commercial |
$3,048.96
|
| Rate for Payer: First Health Commercial |
$3,489.77
|
| Rate for Payer: Humana Commercial |
$3,122.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,012.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,711.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,232.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,755.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,938.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,195.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,534.67
|
| Rate for Payer: PHCS Commercial |
$3,526.50
|
| Rate for Payer: United Healthcare All Payer |
$3,232.63
|
|
|
QUAD HARVESTER 9MM
|
Facility
|
OP
|
$3,673.44
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,102.03 |
| Max. Negotiated Rate |
$3,526.50 |
| Rate for Payer: Aetna Commercial |
$2,828.55
|
| Rate for Payer: Anthem Medicaid |
$1,263.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,865.28
|
| Rate for Payer: Cash Price |
$1,836.72
|
| Rate for Payer: Cigna Commercial |
$3,048.96
|
| Rate for Payer: First Health Commercial |
$3,489.77
|
| Rate for Payer: Humana Commercial |
$3,122.42
|
| Rate for Payer: Humana KY Medicaid |
$1,263.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,276.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,012.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,711.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,288.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,232.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,755.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,938.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,195.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,534.67
|
| Rate for Payer: PHCS Commercial |
$3,526.50
|
| Rate for Payer: United Healthcare All Payer |
$3,232.63
|
|
|
QUADRA ASSURA MP ICD UMRI
|
Facility
|
IP
|
$75,909.40
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,772.82 |
| Max. Negotiated Rate |
$72,873.02 |
| Rate for Payer: Aetna Commercial |
$58,450.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,209.33
|
| Rate for Payer: Cash Price |
$37,954.70
|
| Rate for Payer: Cigna Commercial |
$63,004.80
|
| Rate for Payer: First Health Commercial |
$72,113.93
|
| Rate for Payer: Humana Commercial |
$64,522.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,245.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,021.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,772.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,800.27
|
| Rate for Payer: Ohio Health Group HMO |
$56,932.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,727.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,041.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,377.49
|
| Rate for Payer: PHCS Commercial |
$72,873.02
|
| Rate for Payer: United Healthcare All Payer |
$66,800.27
|
|
|
QUADRA ASSURA MP ICD UMRI
|
Facility
|
OP
|
$75,909.40
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$22,772.82 |
| Max. Negotiated Rate |
$72,873.02 |
| Rate for Payer: Aetna Commercial |
$58,450.24
|
| Rate for Payer: Anthem Medicaid |
$26,105.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,209.33
|
| Rate for Payer: Cash Price |
$37,954.70
|
| Rate for Payer: Cigna Commercial |
$63,004.80
|
| Rate for Payer: First Health Commercial |
$72,113.93
|
| Rate for Payer: Humana Commercial |
$64,522.99
|
| Rate for Payer: Humana KY Medicaid |
$26,105.24
|
| Rate for Payer: Kentucky WC Medicaid |
$26,370.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,245.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,021.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,772.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,629.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,800.27
|
| Rate for Payer: Ohio Health Group HMO |
$56,932.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,727.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,041.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,377.49
|
| Rate for Payer: PHCS Commercial |
$72,873.02
|
| Rate for Payer: United Healthcare All Payer |
$66,800.27
|
|
|
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: Ambetter Exchange |
$707.47
|
| Rate for Payer: Anthem Medicaid |
$549.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$707.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$707.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$848.96
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$707.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.47
|
| 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 |
$919.71
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$554.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$707.47
|
|
|
QUANTIFERON TB GOLD
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 86481
|
| Hospital Charge Code |
30001102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.60
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
QUANTIFERON TB GOLD
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 86481
|
| Hospital Charge Code |
30001102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$100.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$100.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$140.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| 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 |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
QUANTITATIVE SURGICAL CULTURE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
30001254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem Medicaid |
$9.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.89
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Humana KY Medicaid |
$9.89
|
| Rate for Payer: Humana Medicare Advantage |
$9.89
|
| Rate for Payer: Kentucky WC Medicaid |
$9.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.04
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
QUANTITATIVE SURGICAL CULTURE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
30001254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.04
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
QUESTRAN LIGHT(CHOLESTYRAM 4GM
|
Facility
|
OP
|
$10.05
|
|
|
Service Code
|
NDC 245003660
|
| Hospital Charge Code |
25001281
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Anthem Medicaid |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.84
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cigna Commercial |
$8.34
|
| Rate for Payer: First Health Commercial |
$9.55
|
| Rate for Payer: Humana Commercial |
$8.54
|
| Rate for Payer: Humana KY Medicaid |
$3.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.84
|
| Rate for Payer: Ohio Health Group HMO |
$7.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.93
|
| Rate for Payer: PHCS Commercial |
$9.65
|
| Rate for Payer: United Healthcare All Payer |
$8.84
|
|
|
QUESTRAN LIGHT(CHOLESTYRAM 4GM
|
Facility
|
IP
|
$10.05
|
|
|
Service Code
|
NDC 245003660
|
| Hospital Charge Code |
25001281
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.84
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cigna Commercial |
$8.34
|
| Rate for Payer: First Health Commercial |
$9.55
|
| Rate for Payer: Humana Commercial |
$8.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.84
|
| Rate for Payer: Ohio Health Group HMO |
$7.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.93
|
| Rate for Payer: PHCS Commercial |
$9.65
|
| Rate for Payer: United Healthcare All Payer |
$8.84
|
|
|
QUICKANCHOR PLUS 2/0 ETHIBOND
|
Facility
|
OP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem Medicaid |
$1,024.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Humana KY Medicaid |
$1,024.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,034.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,044.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
