|
ANCHOR REELX STT 4.5MM
|
Facility
|
IP
|
$3,959.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.78 |
| Max. Negotiated Rate |
$3,800.89 |
| Rate for Payer: Aetna Commercial |
$3,048.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,088.22
|
| Rate for Payer: Cash Price |
$1,979.63
|
| Rate for Payer: Cigna Commercial |
$3,286.19
|
| Rate for Payer: First Health Commercial |
$3,761.30
|
| Rate for Payer: Humana Commercial |
$3,365.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,246.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,921.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,187.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,484.15
|
| Rate for Payer: Ohio Health Group HMO |
$2,969.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,167.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,444.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,731.89
|
| Rate for Payer: PHCS Commercial |
$3,800.89
|
| Rate for Payer: United Healthcare All Payer |
$3,484.15
|
|
|
ANCHOR REELX STT 4.5MM
|
Facility
|
OP
|
$3,959.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.78 |
| Max. Negotiated Rate |
$3,800.89 |
| Rate for Payer: Aetna Commercial |
$3,048.63
|
| Rate for Payer: Anthem Medicaid |
$1,361.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,088.22
|
| Rate for Payer: Cash Price |
$1,979.63
|
| Rate for Payer: Cigna Commercial |
$3,286.19
|
| Rate for Payer: First Health Commercial |
$3,761.30
|
| Rate for Payer: Humana Commercial |
$3,365.37
|
| Rate for Payer: Humana KY Medicaid |
$1,361.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,375.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,246.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,921.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,187.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,388.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,484.15
|
| Rate for Payer: Ohio Health Group HMO |
$2,969.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,167.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,444.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,731.89
|
| Rate for Payer: PHCS Commercial |
$3,800.89
|
| Rate for Payer: United Healthcare All Payer |
$3,484.15
|
|
|
ANCHOR SUT BIOCOMP TAK #1 FIBE
|
Facility
|
OP
|
$3,593.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
ANCHOR SUT BIOCOMP TAK #1 FIBE
|
Facility
|
IP
|
$3,593.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
ANCHOR SUT BIO-CO S-TAK KNTLS
|
Facility
|
IP
|
$3,593.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
ANCHOR SUT BIO-CO S-TAK KNTLS
|
Facility
|
OP
|
$3,593.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
ANCHOR SUT PEEK S-TAK 3-12.7MM
|
Facility
|
IP
|
$10,026.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,007.88 |
| Max. Negotiated Rate |
$9,625.20 |
| Rate for Payer: Aetna Commercial |
$7,720.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,820.48
|
| Rate for Payer: Cash Price |
$5,013.12
|
| Rate for Payer: Cigna Commercial |
$8,321.79
|
| Rate for Payer: First Health Commercial |
$9,524.94
|
| Rate for Payer: Humana Commercial |
$8,522.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,221.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,007.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,519.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,021.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,722.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,918.11
|
| Rate for Payer: PHCS Commercial |
$9,625.20
|
| Rate for Payer: United Healthcare All Payer |
$8,823.10
|
|
|
ANCHOR SUT PEEK S-TAK 3-12.7MM
|
Facility
|
OP
|
$10,026.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,007.88 |
| Max. Negotiated Rate |
$9,625.20 |
| Rate for Payer: Aetna Commercial |
$7,720.21
|
| Rate for Payer: Anthem Medicaid |
$3,448.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,820.48
|
| Rate for Payer: Cash Price |
$5,013.12
|
| Rate for Payer: Cigna Commercial |
$8,321.79
|
| Rate for Payer: First Health Commercial |
$9,524.94
|
| Rate for Payer: Humana Commercial |
$8,522.31
|
| Rate for Payer: Humana KY Medicaid |
$3,448.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,483.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,221.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,007.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,517.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,519.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,021.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,722.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,918.11
|
| Rate for Payer: PHCS Commercial |
$9,625.20
|
| Rate for Payer: United Healthcare All Payer |
$8,823.10
|
|
|
ANCHOR SUTURE MINI BC SUT TAK
|
Facility
|
OP
|
$3,218.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.62 |
| Max. Negotiated Rate |
$3,090.00 |
| Rate for Payer: Aetna Commercial |
$2,478.44
|
| Rate for Payer: Anthem Medicaid |
$1,106.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.62
|
| Rate for Payer: Cash Price |
$1,609.38
|
| Rate for Payer: Cigna Commercial |
$2,671.56
|
| Rate for Payer: First Health Commercial |
$3,057.81
|
| Rate for Payer: Humana Commercial |
$2,735.94
|
| Rate for Payer: Humana KY Medicaid |
$1,106.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,118.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,129.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,575.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,800.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.94
|
| Rate for Payer: PHCS Commercial |
$3,090.00
|
| Rate for Payer: United Healthcare All Payer |
$2,832.50
|
|
|
ANCHOR SUTURE MINI BC SUT TAK
|
Facility
|
IP
|
$3,218.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.62 |
| Max. Negotiated Rate |
$3,090.00 |
| Rate for Payer: Aetna Commercial |
$2,478.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.62
|
| Rate for Payer: Cash Price |
$1,609.38
|
| Rate for Payer: Cigna Commercial |
$2,671.56
|
| Rate for Payer: First Health Commercial |
$3,057.81
|
| Rate for Payer: Humana Commercial |
$2,735.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,575.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,800.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.94
|
| Rate for Payer: PHCS Commercial |
$3,090.00
|
| Rate for Payer: United Healthcare All Payer |
$2,832.50
|
|
|
ANCHOR SUTURE PUSHLOCK 2.9*12.
|
Facility
|
OP
|
$3,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.50 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem Medicaid |
$1,229.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,967.25
|
| Rate for Payer: First Health Commercial |
$3,396.25
|
| Rate for Payer: Humana Commercial |
$3,038.75
|
| Rate for Payer: Humana KY Medicaid |
$1,229.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,241.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,254.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.75
|
| Rate for Payer: PHCS Commercial |
$3,432.00
|
| Rate for Payer: United Healthcare All Payer |
$3,146.00
|
|
|
ANCHOR SUTURE PUSHLOCK 2.9*12.
|
Facility
|
IP
|
$3,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.50 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,967.25
|
| Rate for Payer: First Health Commercial |
$3,396.25
|
| Rate for Payer: Humana Commercial |
$3,038.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.75
|
| Rate for Payer: PHCS Commercial |
$3,432.00
|
| Rate for Payer: United Healthcare All Payer |
$3,146.00
|
|
|
ANDEXXA 10mg (200mg SDV)
|
Facility
|
IP
|
$13,625.00
|
|
|
Service Code
|
HCPCS J7169
|
| Hospital Charge Code |
25004433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,087.50 |
| Max. Negotiated Rate |
$13,080.00 |
| Rate for Payer: Aetna Commercial |
$10,491.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,627.50
|
| Rate for Payer: Cash Price |
$6,812.50
|
| Rate for Payer: Cigna Commercial |
$11,308.75
|
| Rate for Payer: First Health Commercial |
$12,943.75
|
| Rate for Payer: Humana Commercial |
$11,581.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,172.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,055.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,087.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,990.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,853.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,401.25
|
| Rate for Payer: PHCS Commercial |
$13,080.00
|
| Rate for Payer: United Healthcare All Payer |
$11,990.00
|
|
|
ANDEXXA 10mg (200mg SDV)
|
Facility
|
OP
|
$13,625.00
|
|
|
Service Code
|
HCPCS J7169
|
| Hospital Charge Code |
25004433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.56 |
| Max. Negotiated Rate |
$13,080.00 |
| Rate for Payer: Aetna Commercial |
$10,491.25
|
| Rate for Payer: Anthem Medicaid |
$4,685.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$131.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,627.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$184.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$177.61
|
| Rate for Payer: Cash Price |
$6,812.50
|
| Rate for Payer: Cash Price |
$6,812.50
|
| Rate for Payer: Cigna Commercial |
$11,308.75
|
| Rate for Payer: First Health Commercial |
$12,943.75
|
| Rate for Payer: Humana Commercial |
$11,581.25
|
| Rate for Payer: Humana KY Medicaid |
$4,685.64
|
| Rate for Payer: Humana Medicare Advantage |
$131.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,172.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,055.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,779.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,990.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,853.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,401.25
|
| Rate for Payer: PHCS Commercial |
$13,080.00
|
| Rate for Payer: United Healthcare All Payer |
$11,990.00
|
|
|
ANE COSM UNLIST 90 M PX
|
Professional
|
Both
|
$315.00
|
|
| Hospital Charge Code |
37000252
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$110.25
|
|
|
ANE COSM UNLIST 90 M PX
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
37000252
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
ANE COSM UNLIST 90 M PX
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
37000252
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
ANECREAM 4% CREAM (30GM)
|
Facility
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 24357070130
|
| Hospital Charge Code |
25002835
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna Commercial |
$0.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.68
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna Commercial |
$0.72
|
| Rate for Payer: First Health Commercial |
$0.83
|
| Rate for Payer: Humana Commercial |
$0.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.77
|
| Rate for Payer: Ohio Health Group HMO |
$0.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.60
|
| Rate for Payer: PHCS Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Payer |
$0.77
|
|
|
ANECREAM 4% CREAM (30GM)
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 24357070130
|
| Hospital Charge Code |
25002835
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna Commercial |
$0.67
|
| Rate for Payer: Anthem Medicaid |
$0.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.68
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna Commercial |
$0.72
|
| Rate for Payer: First Health Commercial |
$0.83
|
| Rate for Payer: Humana Commercial |
$0.74
|
| Rate for Payer: Humana KY Medicaid |
$0.30
|
| Rate for Payer: Kentucky WC Medicaid |
$0.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.77
|
| Rate for Payer: Ohio Health Group HMO |
$0.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.60
|
| Rate for Payer: PHCS Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Payer |
$0.77
|
|
|
ANECTINE 20MG/1ML(200MG/10 ML
|
Facility
|
OP
|
$126.37
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
25001869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$121.32 |
| Rate for Payer: Aetna Commercial |
$97.30
|
| Rate for Payer: Anthem Medicaid |
$43.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.57
|
| Rate for Payer: Cash Price |
$63.19
|
| Rate for Payer: Cigna Commercial |
$104.89
|
| Rate for Payer: First Health Commercial |
$120.05
|
| Rate for Payer: Humana Commercial |
$107.41
|
| Rate for Payer: Humana KY Medicaid |
$43.46
|
| Rate for Payer: Kentucky WC Medicaid |
$43.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.21
|
| Rate for Payer: Ohio Health Group HMO |
$94.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.20
|
| Rate for Payer: PHCS Commercial |
$121.32
|
| Rate for Payer: United Healthcare All Payer |
$111.21
|
|
|
ANECTINE 20MG/1ML(200MG/10 ML
|
Facility
|
IP
|
$126.37
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
25001869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$121.32 |
| Rate for Payer: Aetna Commercial |
$97.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.57
|
| Rate for Payer: Cash Price |
$63.19
|
| Rate for Payer: Cigna Commercial |
$104.89
|
| Rate for Payer: First Health Commercial |
$120.05
|
| Rate for Payer: Humana Commercial |
$107.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.21
|
| Rate for Payer: Ohio Health Group HMO |
$94.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.20
|
| Rate for Payer: PHCS Commercial |
$121.32
|
| Rate for Payer: United Healthcare All Payer |
$111.21
|
|
|
ANES Albumin 25% (12.5gm/50mL)
|
Facility
|
OP
|
$326.40
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
25004140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.92 |
| Max. Negotiated Rate |
$313.34 |
| Rate for Payer: Aetna Commercial |
$251.33
|
| Rate for Payer: Anthem Medicaid |
$112.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$254.59
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$270.91
|
| Rate for Payer: First Health Commercial |
$310.08
|
| Rate for Payer: Humana Commercial |
$277.44
|
| Rate for Payer: Humana KY Medicaid |
$112.25
|
| Rate for Payer: Kentucky WC Medicaid |
$113.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$267.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$240.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.23
|
| Rate for Payer: Ohio Health Group HMO |
$244.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$261.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.22
|
| Rate for Payer: PHCS Commercial |
$313.34
|
| Rate for Payer: United Healthcare All Payer |
$287.23
|
|
|
ANES Albumin 25% (12.5gm/50mL)
|
Facility
|
IP
|
$326.40
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
25004140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.92 |
| Max. Negotiated Rate |
$313.34 |
| Rate for Payer: Aetna Commercial |
$251.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$254.59
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$270.91
|
| Rate for Payer: First Health Commercial |
$310.08
|
| Rate for Payer: Humana Commercial |
$277.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$267.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$240.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.23
|
| Rate for Payer: Ohio Health Group HMO |
$244.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$261.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.22
|
| Rate for Payer: PHCS Commercial |
$313.34
|
| Rate for Payer: United Healthcare All Payer |
$287.23
|
|
|
ANES Albumin 5% (12.5gm/250mL)
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
25004141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.70 |
| Max. Negotiated Rate |
$344.64 |
| Rate for Payer: Aetna Commercial |
$276.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.02
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$297.97
|
| Rate for Payer: First Health Commercial |
$341.05
|
| Rate for Payer: Humana Commercial |
$305.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.92
|
| Rate for Payer: Ohio Health Group HMO |
$269.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.71
|
| Rate for Payer: PHCS Commercial |
$344.64
|
| Rate for Payer: United Healthcare All Payer |
$315.92
|
|
|
ANES Albumin 5% (12.5gm/250mL)
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
25004141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.08 |
| Max. Negotiated Rate |
$344.64 |
| Rate for Payer: Aetna Commercial |
$276.43
|
| Rate for Payer: Anthem Medicaid |
$123.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$53.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.66
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$297.97
|
| Rate for Payer: First Health Commercial |
$341.05
|
| Rate for Payer: Humana Commercial |
$305.15
|
| Rate for Payer: Humana KY Medicaid |
$123.46
|
| Rate for Payer: Humana Medicare Advantage |
$53.08
|
| Rate for Payer: Kentucky WC Medicaid |
$124.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$125.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.92
|
| Rate for Payer: Ohio Health Group HMO |
$269.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.71
|
| Rate for Payer: PHCS Commercial |
$344.64
|
| Rate for Payer: United Healthcare All Payer |
$315.92
|
|
