|
ANAT SHOULDER REM HEAD 16*46
|
Facility
|
OP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem Medicaid |
$3,744.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Humana KY Medicaid |
$3,744.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 16*46
|
Facility
|
IP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 17*48
|
Facility
|
OP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem Medicaid |
$3,744.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Humana KY Medicaid |
$3,744.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 17*48
|
Facility
|
IP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 18*50
|
Facility
|
IP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 18*50
|
Facility
|
OP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem Medicaid |
$3,744.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Humana KY Medicaid |
$3,744.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 19*52
|
Facility
|
IP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 19*52
|
Facility
|
OP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem Medicaid |
$3,744.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Humana KY Medicaid |
$3,744.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 20*48
|
Facility
|
OP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem Medicaid |
$3,744.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Humana KY Medicaid |
$3,744.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 20*48
|
Facility
|
IP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 21*50
|
Facility
|
OP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem Medicaid |
$3,744.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Humana KY Medicaid |
$3,744.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 21*50
|
Facility
|
IP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Facility
|
IP
|
$59.03
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
636T0018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$56.67 |
| Rate for Payer: Aetna Commercial |
$45.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.04
|
| Rate for Payer: Cash Price |
$29.52
|
| Rate for Payer: Cigna Commercial |
$48.99
|
| Rate for Payer: First Health Commercial |
$56.08
|
| Rate for Payer: Humana Commercial |
$50.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.95
|
| Rate for Payer: Ohio Health Group HMO |
$44.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.73
|
| Rate for Payer: PHCS Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Payer |
$51.95
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Facility
|
IP
|
$118.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001924
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$113.33 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.08
|
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Cigna Commercial |
$97.98
|
| Rate for Payer: First Health Commercial |
$112.15
|
| Rate for Payer: Humana Commercial |
$100.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.88
|
| Rate for Payer: Ohio Health Group HMO |
$88.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.45
|
| Rate for Payer: PHCS Commercial |
$113.33
|
| Rate for Payer: United Healthcare All Payer |
$103.88
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Facility
|
OP
|
$118.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001924
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$113.33 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Anthem Medicaid |
$40.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.08
|
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Cigna Commercial |
$97.98
|
| Rate for Payer: First Health Commercial |
$112.15
|
| Rate for Payer: Humana Commercial |
$100.34
|
| Rate for Payer: Humana KY Medicaid |
$40.60
|
| Rate for Payer: Kentucky WC Medicaid |
$41.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.88
|
| Rate for Payer: Ohio Health Group HMO |
$88.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.45
|
| Rate for Payer: PHCS Commercial |
$113.33
|
| Rate for Payer: United Healthcare All Payer |
$103.88
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Facility
|
IP
|
$59.03
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
63600018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$56.67 |
| Rate for Payer: Aetna Commercial |
$45.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.04
|
| Rate for Payer: Cash Price |
$29.52
|
| Rate for Payer: Cigna Commercial |
$48.99
|
| Rate for Payer: First Health Commercial |
$56.08
|
| Rate for Payer: Humana Commercial |
$50.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.95
|
| Rate for Payer: Ohio Health Group HMO |
$44.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.73
|
| Rate for Payer: PHCS Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Payer |
$51.95
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Professional
|
Both
|
$59.03
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
63600018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Aetna Commercial |
$1.03
|
| Rate for Payer: Ambetter Exchange |
$0.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.01
|
| Rate for Payer: Cash Price |
$29.52
|
| Rate for Payer: Cash Price |
$29.52
|
| Rate for Payer: Healthspan PPO |
$1.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.84
|
| Rate for Payer: Multiplan PHCS |
$35.42
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1.09
|
| Rate for Payer: UHCCP Medicaid |
$20.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.84
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Facility
|
OP
|
$59.03
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
636T0018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$56.67 |
| Rate for Payer: Aetna Commercial |
$45.45
|
| Rate for Payer: Anthem Medicaid |
$20.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.04
|
| Rate for Payer: Cash Price |
$29.52
|
| Rate for Payer: Cigna Commercial |
$48.99
|
| Rate for Payer: First Health Commercial |
$56.08
|
| Rate for Payer: Humana Commercial |
$50.18
|
| Rate for Payer: Humana KY Medicaid |
$20.30
|
| Rate for Payer: Kentucky WC Medicaid |
$20.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.95
|
| Rate for Payer: Ohio Health Group HMO |
$44.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.73
|
| Rate for Payer: PHCS Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Payer |
$51.95
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Facility
|
OP
|
$59.03
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
63600018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$56.67 |
| Rate for Payer: Aetna Commercial |
$45.45
|
| Rate for Payer: Anthem Medicaid |
$20.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.04
|
| Rate for Payer: Cash Price |
$29.52
|
| Rate for Payer: Cigna Commercial |
$48.99
|
| Rate for Payer: First Health Commercial |
$56.08
|
| Rate for Payer: Humana Commercial |
$50.18
|
| Rate for Payer: Humana KY Medicaid |
$20.30
|
| Rate for Payer: Kentucky WC Medicaid |
$20.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.95
|
| Rate for Payer: Ohio Health Group HMO |
$44.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.73
|
| Rate for Payer: PHCS Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Payer |
$51.95
|
|
|
ANCEF 500 MG 1GM VL
|
Facility
|
IP
|
$77.65
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001927
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$74.54 |
| Rate for Payer: Aetna Commercial |
$59.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.57
|
| Rate for Payer: Cash Price |
$38.83
|
| Rate for Payer: Cigna Commercial |
$64.45
|
| Rate for Payer: First Health Commercial |
$73.77
|
| Rate for Payer: Humana Commercial |
$66.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.33
|
| Rate for Payer: Ohio Health Group HMO |
$58.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.58
|
| Rate for Payer: PHCS Commercial |
$74.54
|
| Rate for Payer: United Healthcare All Payer |
$68.33
|
|
|
ANCEF 500 MG 1GM VL
|
Facility
|
OP
|
$77.65
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001927
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$74.54 |
| Rate for Payer: Aetna Commercial |
$59.79
|
| Rate for Payer: Anthem Medicaid |
$26.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.57
|
| Rate for Payer: Cash Price |
$38.83
|
| Rate for Payer: Cigna Commercial |
$64.45
|
| Rate for Payer: First Health Commercial |
$73.77
|
| Rate for Payer: Humana Commercial |
$66.00
|
| Rate for Payer: Humana KY Medicaid |
$26.70
|
| Rate for Payer: Kentucky WC Medicaid |
$26.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.33
|
| Rate for Payer: Ohio Health Group HMO |
$58.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.58
|
| Rate for Payer: PHCS Commercial |
$74.54
|
| Rate for Payer: United Healthcare All Payer |
$68.33
|
|
|
ANCEF 500 MG (2GM SYRINGE)
|
Facility
|
IP
|
$118.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$113.33 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.08
|
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Cigna Commercial |
$97.98
|
| Rate for Payer: First Health Commercial |
$112.15
|
| Rate for Payer: Humana Commercial |
$100.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.88
|
| Rate for Payer: Ohio Health Group HMO |
$88.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.45
|
| Rate for Payer: PHCS Commercial |
$113.33
|
| Rate for Payer: United Healthcare All Payer |
$103.88
|
|
|
ANCEF 500 MG (2GM SYRINGE)
|
Facility
|
OP
|
$118.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$113.33 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Anthem Medicaid |
$40.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.08
|
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Cigna Commercial |
$97.98
|
| Rate for Payer: First Health Commercial |
$112.15
|
| Rate for Payer: Humana Commercial |
$100.34
|
| Rate for Payer: Humana KY Medicaid |
$40.60
|
| Rate for Payer: Kentucky WC Medicaid |
$41.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.88
|
| Rate for Payer: Ohio Health Group HMO |
$88.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.45
|
| Rate for Payer: PHCS Commercial |
$113.33
|
| Rate for Payer: United Healthcare All Payer |
$103.88
|
|
|
ANCEF 500 MG [3GRAM/30ML]
|
Facility
|
OP
|
$118.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$113.33 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Anthem Medicaid |
$40.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.08
|
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Cigna Commercial |
$97.98
|
| Rate for Payer: First Health Commercial |
$112.15
|
| Rate for Payer: Humana Commercial |
$100.34
|
| Rate for Payer: Humana KY Medicaid |
$40.60
|
| Rate for Payer: Kentucky WC Medicaid |
$41.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.88
|
| Rate for Payer: Ohio Health Group HMO |
$88.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.45
|
| Rate for Payer: PHCS Commercial |
$113.33
|
| Rate for Payer: United Healthcare All Payer |
$103.88
|
|
|
ANCEF 500 MG [3GRAM/30ML]
|
Facility
|
IP
|
$118.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$113.33 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.08
|
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Cigna Commercial |
$97.98
|
| Rate for Payer: First Health Commercial |
$112.15
|
| Rate for Payer: Humana Commercial |
$100.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.88
|
| Rate for Payer: Ohio Health Group HMO |
$88.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.45
|
| Rate for Payer: PHCS Commercial |
$113.33
|
| Rate for Payer: United Healthcare All Payer |
$103.88
|
|
