|
GELSYN-3 0.1mg(16.8mg) SYR
|
Professional
|
Both
|
$12.59
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$7.55 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Ambetter Exchange |
$0.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.78
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.65
|
| Rate for Payer: Multiplan PHCS |
$7.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.85
|
| Rate for Payer: UHCCP Medicaid |
$4.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.65
|
|
|
GELSYN-3 0.1mg(16.8mg) SYR
|
Facility
|
IP
|
$2,114.60
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
25004209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$634.38 |
| Max. Negotiated Rate |
$2,030.02 |
| Rate for Payer: Aetna Commercial |
$1,628.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,649.39
|
| Rate for Payer: Cash Price |
$1,057.30
|
| Rate for Payer: Cigna Commercial |
$1,755.12
|
| Rate for Payer: First Health Commercial |
$2,008.87
|
| Rate for Payer: Humana Commercial |
$1,797.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,839.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.07
|
| Rate for Payer: PHCS Commercial |
$2,030.02
|
| Rate for Payer: United Healthcare All Payer |
$1,860.85
|
|
|
GELSYN-3 0.1mg(16.8mg) SYR
|
Facility
|
IP
|
$12.59
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
636T0161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$12.09 |
| Rate for Payer: Aetna Commercial |
$9.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.82
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$10.45
|
| Rate for Payer: First Health Commercial |
$11.96
|
| Rate for Payer: Humana Commercial |
$10.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.08
|
| Rate for Payer: Ohio Health Group HMO |
$9.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.69
|
| Rate for Payer: PHCS Commercial |
$12.09
|
| Rate for Payer: United Healthcare All Payer |
$11.08
|
|
|
GELSYN-3 0.1mg(16.8mg) SYR
|
Facility
|
OP
|
$12.59
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
636T0161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$12.09 |
| Rate for Payer: Aetna Commercial |
$9.69
|
| Rate for Payer: Anthem Medicaid |
$4.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.82
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$10.45
|
| Rate for Payer: First Health Commercial |
$11.96
|
| Rate for Payer: Humana Commercial |
$10.70
|
| Rate for Payer: Humana KY Medicaid |
$4.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.08
|
| Rate for Payer: Ohio Health Group HMO |
$9.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.69
|
| Rate for Payer: PHCS Commercial |
$12.09
|
| Rate for Payer: United Healthcare All Payer |
$11.08
|
|
|
GELSYN-3 0.1mg(16.8mg) SYR
|
Facility
|
OP
|
$2,114.60
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
25004209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$634.38 |
| Max. Negotiated Rate |
$2,030.02 |
| Rate for Payer: Aetna Commercial |
$1,628.24
|
| Rate for Payer: Anthem Medicaid |
$727.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,649.39
|
| Rate for Payer: Cash Price |
$1,057.30
|
| Rate for Payer: Cigna Commercial |
$1,755.12
|
| Rate for Payer: First Health Commercial |
$2,008.87
|
| Rate for Payer: Humana Commercial |
$1,797.41
|
| Rate for Payer: Humana KY Medicaid |
$727.21
|
| Rate for Payer: Kentucky WC Medicaid |
$734.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$741.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,839.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.07
|
| Rate for Payer: PHCS Commercial |
$2,030.02
|
| Rate for Payer: United Healthcare All Payer |
$1,860.85
|
|
|
GELSYN-3 0.1mg(16.8mg) SYR
|
Facility
|
OP
|
$12.59
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$12.09 |
| Rate for Payer: Aetna Commercial |
$9.69
|
| Rate for Payer: Anthem Medicaid |
$4.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.82
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$10.45
|
| Rate for Payer: First Health Commercial |
$11.96
|
| Rate for Payer: Humana Commercial |
$10.70
|
| Rate for Payer: Humana KY Medicaid |
$4.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.08
|
| Rate for Payer: Ohio Health Group HMO |
$9.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.69
|
| Rate for Payer: PHCS Commercial |
$12.09
|
| Rate for Payer: United Healthcare All Payer |
$11.08
|
|
|
GELSYN-3 0.1mg(16.8mg) SYR
|
Facility
|
IP
|
$12.59
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$12.09 |
| Rate for Payer: Aetna Commercial |
$9.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.82
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$10.45
|
| Rate for Payer: First Health Commercial |
$11.96
|
| Rate for Payer: Humana Commercial |
$10.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.08
|
| Rate for Payer: Ohio Health Group HMO |
$9.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.69
|
| Rate for Payer: PHCS Commercial |
$12.09
|
| Rate for Payer: United Healthcare All Payer |
$11.08
|
|
|
GEMZAR 1GM/26.3ML VIAL
|
Facility
|
OP
|
$246.89
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
25002619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$237.01 |
| Rate for Payer: Aetna Commercial |
$190.11
|
| Rate for Payer: Anthem Medicaid |
$84.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.57
|
| Rate for Payer: Cash Price |
$123.44
|
| Rate for Payer: Cigna Commercial |
$204.92
|
| Rate for Payer: First Health Commercial |
$234.55
|
| Rate for Payer: Humana Commercial |
$209.86
|
| Rate for Payer: Humana KY Medicaid |
$84.91
|
| Rate for Payer: Kentucky WC Medicaid |
$85.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$202.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$182.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$86.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$217.26
|
| Rate for Payer: Ohio Health Group HMO |
$185.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.35
|
| Rate for Payer: PHCS Commercial |
$237.01
|
| Rate for Payer: United Healthcare All Payer |
$217.26
|
|
|
GEMZAR 1GM/26.3ML VIAL
|
Facility
|
IP
|
$246.89
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
25002619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$237.01 |
| Rate for Payer: Aetna Commercial |
$190.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.57
|
| Rate for Payer: Cash Price |
$123.44
|
| Rate for Payer: Cigna Commercial |
$204.92
|
| Rate for Payer: First Health Commercial |
$234.55
|
| Rate for Payer: Humana Commercial |
$209.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$202.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$182.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$217.26
|
| Rate for Payer: Ohio Health Group HMO |
$185.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.35
|
| Rate for Payer: PHCS Commercial |
$237.01
|
| Rate for Payer: United Healthcare All Payer |
$217.26
|
|
|
GEMZAR 200MG (1G/50ML VIAL)
|
Facility
|
IP
|
$267.05
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
25002622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.11 |
| Max. Negotiated Rate |
$256.37 |
| Rate for Payer: Aetna Commercial |
$205.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.30
|
| Rate for Payer: Cash Price |
$133.52
|
| Rate for Payer: Cigna Commercial |
$221.65
|
| Rate for Payer: First Health Commercial |
$253.70
|
| Rate for Payer: Humana Commercial |
$226.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$235.00
|
| Rate for Payer: Ohio Health Group HMO |
$200.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.26
|
| Rate for Payer: PHCS Commercial |
$256.37
|
| Rate for Payer: United Healthcare All Payer |
$235.00
|
|
|
GEMZAR 200MG (1G/50ML VIAL)
|
Facility
|
OP
|
$267.05
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
25002622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.11 |
| Max. Negotiated Rate |
$256.37 |
| Rate for Payer: Aetna Commercial |
$205.63
|
| Rate for Payer: Anthem Medicaid |
$91.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.30
|
| Rate for Payer: Cash Price |
$133.52
|
| Rate for Payer: Cigna Commercial |
$221.65
|
| Rate for Payer: First Health Commercial |
$253.70
|
| Rate for Payer: Humana Commercial |
$226.99
|
| Rate for Payer: Humana KY Medicaid |
$91.84
|
| Rate for Payer: Kentucky WC Medicaid |
$92.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$235.00
|
| Rate for Payer: Ohio Health Group HMO |
$200.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.26
|
| Rate for Payer: PHCS Commercial |
$256.37
|
| Rate for Payer: United Healthcare All Payer |
$235.00
|
|
|
GEMZAR (GEMCITABINE) 200 MG C
|
Facility
|
OP
|
$65.40
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
25002621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$62.78 |
| Rate for Payer: Aetna Commercial |
$50.36
|
| Rate for Payer: Anthem Medicaid |
$22.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.01
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: First Health Commercial |
$62.13
|
| Rate for Payer: Humana Commercial |
$55.59
|
| Rate for Payer: Humana KY Medicaid |
$22.49
|
| Rate for Payer: Kentucky WC Medicaid |
$22.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.55
|
| Rate for Payer: Ohio Health Group HMO |
$49.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.13
|
| Rate for Payer: PHCS Commercial |
$62.78
|
| Rate for Payer: United Healthcare All Payer |
$57.55
|
|
|
GEMZAR (GEMCITABINE) 200 MG C
|
Facility
|
IP
|
$65.40
|
|
|
Service Code
|
HCPCS J9201
|
| Hospital Charge Code |
25002621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$62.78 |
| Rate for Payer: Aetna Commercial |
$50.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.01
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: First Health Commercial |
$62.13
|
| Rate for Payer: Humana Commercial |
$55.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.55
|
| Rate for Payer: Ohio Health Group HMO |
$49.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.13
|
| Rate for Payer: PHCS Commercial |
$62.78
|
| Rate for Payer: United Healthcare All Payer |
$57.55
|
|
|
GEN CEM FINNED TIB BASE LGE LT
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GEN CEM FINNED TIB BASE LGE LT
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GEN CEM FINNED TIB BASE MAG LT
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GEN CEM FINNED TIB BASE MAG LT
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GEN CEM FINNED TIB BASE MED LT
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GEN CEM FINNED TIB BASE MED LT
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GEN CEM FINNED TIB BASE SM LFT
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GEN CEM FINNED TIB BASE SM LFT
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GEN CEM FINNED TIB BASE XLG LT
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GEN CEM FINNED TIB BASE XLG LT
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GEN CR ART LRG LT INSERT 8MM
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GEN CR ART LRG LT INSERT 8MM
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
