|
HYDROXYZINE 25MG (50MG VIAL)
|
Facility
|
IP
|
$175.82
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
25002422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.75 |
| Max. Negotiated Rate |
$168.79 |
| Rate for Payer: Aetna Commercial |
$135.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.14
|
| Rate for Payer: Cash Price |
$87.91
|
| Rate for Payer: Cigna Commercial |
$145.93
|
| Rate for Payer: First Health Commercial |
$167.03
|
| Rate for Payer: Humana Commercial |
$149.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.72
|
| Rate for Payer: Ohio Health Group HMO |
$131.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.32
|
| Rate for Payer: PHCS Commercial |
$168.79
|
| Rate for Payer: United Healthcare All Payer |
$154.72
|
|
|
HYDROXYZINE 25MG (50MG VIAL)
|
Facility
|
OP
|
$175.82
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
25002422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.75 |
| Max. Negotiated Rate |
$168.79 |
| Rate for Payer: Aetna Commercial |
$135.38
|
| Rate for Payer: Anthem Medicaid |
$60.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.14
|
| Rate for Payer: Cash Price |
$87.91
|
| Rate for Payer: Cigna Commercial |
$145.93
|
| Rate for Payer: First Health Commercial |
$167.03
|
| Rate for Payer: Humana Commercial |
$149.45
|
| Rate for Payer: Humana KY Medicaid |
$60.46
|
| Rate for Payer: Kentucky WC Medicaid |
$61.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.72
|
| Rate for Payer: Ohio Health Group HMO |
$131.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.32
|
| Rate for Payer: PHCS Commercial |
$168.79
|
| Rate for Payer: United Healthcare All Payer |
$154.72
|
|
|
HYGROTON 25MG TABLET
|
Facility
|
IP
|
$5.17
|
|
|
Service Code
|
NDC 378022201
|
| Hospital Charge Code |
25000765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.03
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna Commercial |
$4.29
|
| Rate for Payer: First Health Commercial |
$4.91
|
| Rate for Payer: Humana Commercial |
$4.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.55
|
| Rate for Payer: Ohio Health Group HMO |
$3.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.57
|
| Rate for Payer: PHCS Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Payer |
$4.55
|
|
|
HYGROTON 25MG TABLET
|
Facility
|
OP
|
$5.17
|
|
|
Service Code
|
NDC 378022201
|
| Hospital Charge Code |
25000765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Anthem Medicaid |
$1.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.03
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna Commercial |
$4.29
|
| Rate for Payer: First Health Commercial |
$4.91
|
| Rate for Payer: Humana Commercial |
$4.39
|
| Rate for Payer: Humana KY Medicaid |
$1.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.55
|
| Rate for Payer: Ohio Health Group HMO |
$3.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.57
|
| Rate for Payer: PHCS Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Payer |
$4.55
|
|
|
HYLENEX 1unit (150unit SDV)
|
Facility
|
OP
|
$304.11
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
25004348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.23 |
| Max. Negotiated Rate |
$291.95 |
| Rate for Payer: Aetna Commercial |
$234.16
|
| Rate for Payer: Anthem Medicaid |
$104.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.21
|
| Rate for Payer: Cash Price |
$152.06
|
| Rate for Payer: Cigna Commercial |
$252.41
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: Humana Commercial |
$258.49
|
| Rate for Payer: Humana KY Medicaid |
$104.58
|
| Rate for Payer: Kentucky WC Medicaid |
$105.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.62
|
| Rate for Payer: Ohio Health Group HMO |
$228.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.84
|
| Rate for Payer: PHCS Commercial |
$291.95
|
| Rate for Payer: United Healthcare All Payer |
$267.62
|
|
|
HYLENEX 1unit (150unit SDV)
|
Facility
|
IP
|
$304.11
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
25004348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.23 |
| Max. Negotiated Rate |
$291.95 |
| Rate for Payer: Aetna Commercial |
$234.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.21
|
| Rate for Payer: Cash Price |
$152.06
|
| Rate for Payer: Cigna Commercial |
$252.41
|
| Rate for Payer: First Health Commercial |
$288.90
|
| Rate for Payer: Humana Commercial |
$258.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.62
|
| Rate for Payer: Ohio Health Group HMO |
$228.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.84
|
| Rate for Payer: PHCS Commercial |
$291.95
|
| Rate for Payer: United Healthcare All Payer |
$267.62
|
|
|
HYOSCYAMINE 0.25mg (0.5mg SDV)
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS J1980
|
| Hospital Charge Code |
25002214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
HYOSCYAMINE 0.25mg (0.5mg SDV)
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS J1980
|
| Hospital Charge Code |
25002214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
HYPERRAB 150 IU (1500 U VIAL)
|
Facility
|
OP
|
$18,543.46
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
25000007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$266.44 |
| Max. Negotiated Rate |
$17,801.72 |
| Rate for Payer: Aetna Commercial |
$14,278.46
|
| Rate for Payer: Anthem Medicaid |
$6,377.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$266.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,463.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$373.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$359.69
|
| Rate for Payer: Cash Price |
$9,271.73
|
| Rate for Payer: Cash Price |
$9,271.73
|
| Rate for Payer: Cigna Commercial |
$15,391.07
|
| Rate for Payer: First Health Commercial |
$17,616.29
|
| Rate for Payer: Humana Commercial |
$15,761.94
|
| Rate for Payer: Humana KY Medicaid |
$6,377.10
|
| Rate for Payer: Humana Medicare Advantage |
$266.44
|
| Rate for Payer: Kentucky WC Medicaid |
$6,442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,205.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,685.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,505.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,318.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,907.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,834.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,132.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,794.99
|
| Rate for Payer: PHCS Commercial |
$17,801.72
|
| Rate for Payer: United Healthcare All Payer |
$16,318.24
|
|
|
HYPERRAB 150 IU (1500 U VIAL)
|
Facility
|
IP
|
$18,543.46
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
25000007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,563.04 |
| Max. Negotiated Rate |
$17,801.72 |
| Rate for Payer: Aetna Commercial |
$14,278.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,463.90
|
| Rate for Payer: Cash Price |
$9,271.73
|
| Rate for Payer: Cigna Commercial |
$15,391.07
|
| Rate for Payer: First Health Commercial |
$17,616.29
|
| Rate for Payer: Humana Commercial |
$15,761.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,205.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,685.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,563.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,318.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,907.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,834.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,132.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,794.99
|
| Rate for Payer: PHCS Commercial |
$17,801.72
|
| Rate for Payer: United Healthcare All Payer |
$16,318.24
|
|
|
HYPERRAB 150 IU (300 U VIAL)
|
Facility
|
OP
|
$3,708.73
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
25000006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$266.44 |
| Max. Negotiated Rate |
$3,560.38 |
| Rate for Payer: Aetna Commercial |
$2,855.72
|
| Rate for Payer: Anthem Medicaid |
$1,275.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$266.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,892.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$373.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$359.69
|
| Rate for Payer: Cash Price |
$1,854.37
|
| Rate for Payer: Cash Price |
$1,854.37
|
| Rate for Payer: Cigna Commercial |
$3,078.25
|
| Rate for Payer: First Health Commercial |
$3,523.29
|
| Rate for Payer: Humana Commercial |
$3,152.42
|
| Rate for Payer: Humana KY Medicaid |
$1,275.43
|
| Rate for Payer: Humana Medicare Advantage |
$266.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,288.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,041.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,737.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,301.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,263.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,781.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,966.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,226.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,559.02
|
| Rate for Payer: PHCS Commercial |
$3,560.38
|
| Rate for Payer: United Healthcare All Payer |
$3,263.68
|
|
|
HYPERRAB 150 IU (300 U VIAL)
|
Facility
|
IP
|
$3,708.73
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
25000006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,112.62 |
| Max. Negotiated Rate |
$3,560.38 |
| Rate for Payer: Aetna Commercial |
$2,855.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,892.81
|
| Rate for Payer: Cash Price |
$1,854.37
|
| Rate for Payer: Cigna Commercial |
$3,078.25
|
| Rate for Payer: First Health Commercial |
$3,523.29
|
| Rate for Payer: Humana Commercial |
$3,152.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,041.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,737.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,112.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,263.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,781.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,966.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,226.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,559.02
|
| Rate for Payer: PHCS Commercial |
$3,560.38
|
| Rate for Payer: United Healthcare All Payer |
$3,263.68
|
|
|
HYPERRAB 150 IU (900 U VIAL)
|
Facility
|
IP
|
$11,126.12
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
25004087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,337.84 |
| Max. Negotiated Rate |
$10,681.08 |
| Rate for Payer: Aetna Commercial |
$8,567.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,678.37
|
| Rate for Payer: Cash Price |
$5,563.06
|
| Rate for Payer: Cigna Commercial |
$9,234.68
|
| Rate for Payer: First Health Commercial |
$10,569.81
|
| Rate for Payer: Humana Commercial |
$9,457.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,123.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,211.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,337.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,790.99
|
| Rate for Payer: Ohio Health Group HMO |
$8,344.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,900.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,679.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,677.02
|
| Rate for Payer: PHCS Commercial |
$10,681.08
|
| Rate for Payer: United Healthcare All Payer |
$9,790.99
|
|
|
HYPERRAB 150 IU (900 U VIAL)
|
Facility
|
OP
|
$11,126.12
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
25004087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$266.44 |
| Max. Negotiated Rate |
$10,681.08 |
| Rate for Payer: Aetna Commercial |
$8,567.11
|
| Rate for Payer: Anthem Medicaid |
$3,826.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$266.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,678.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$373.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$359.69
|
| Rate for Payer: Cash Price |
$5,563.06
|
| Rate for Payer: Cash Price |
$5,563.06
|
| Rate for Payer: Cigna Commercial |
$9,234.68
|
| Rate for Payer: First Health Commercial |
$10,569.81
|
| Rate for Payer: Humana Commercial |
$9,457.20
|
| Rate for Payer: Humana KY Medicaid |
$3,826.27
|
| Rate for Payer: Humana Medicare Advantage |
$266.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,865.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,123.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,211.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,903.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,790.99
|
| Rate for Payer: Ohio Health Group HMO |
$8,344.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,900.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,679.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,677.02
|
| Rate for Payer: PHCS Commercial |
$10,681.08
|
| Rate for Payer: United Healthcare All Payer |
$9,790.99
|
|
|
HYPER-TET(TET IMM GLO 250U/1ML
|
Facility
|
IP
|
$1,572.26
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
25002154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$471.68 |
| Max. Negotiated Rate |
$1,509.37 |
| Rate for Payer: Aetna Commercial |
$1,210.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.36
|
| Rate for Payer: Cash Price |
$786.13
|
| Rate for Payer: Cigna Commercial |
$1,304.98
|
| Rate for Payer: First Health Commercial |
$1,493.65
|
| Rate for Payer: Humana Commercial |
$1,336.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,257.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,367.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,084.86
|
| Rate for Payer: PHCS Commercial |
$1,509.37
|
| Rate for Payer: United Healthcare All Payer |
$1,383.59
|
|
|
HYPER-TET(TET IMM GLO 250U/1ML
|
Facility
|
OP
|
$1,572.26
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
25002154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$540.70 |
| Max. Negotiated Rate |
$1,509.37 |
| Rate for Payer: Aetna Commercial |
$1,210.64
|
| Rate for Payer: Anthem Medicaid |
$540.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$577.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$807.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$779.02
|
| Rate for Payer: Cash Price |
$786.13
|
| Rate for Payer: Cash Price |
$786.13
|
| Rate for Payer: Cigna Commercial |
$1,304.98
|
| Rate for Payer: First Health Commercial |
$1,493.65
|
| Rate for Payer: Humana Commercial |
$1,336.42
|
| Rate for Payer: Humana KY Medicaid |
$540.70
|
| Rate for Payer: Humana Medicare Advantage |
$577.05
|
| Rate for Payer: Kentucky WC Medicaid |
$546.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$551.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,257.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,367.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,084.86
|
| Rate for Payer: PHCS Commercial |
$1,509.37
|
| Rate for Payer: United Healthcare All Payer |
$1,383.59
|
|
|
HYPOCURE SINUS TARSI IMP SZ 10
|
Facility
|
OP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem Medicaid |
$3,014.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Humana KY Medicaid |
$3,014.97
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 10
|
Facility
|
IP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 5
|
Facility
|
IP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 5
|
Facility
|
OP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem Medicaid |
$3,014.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Humana KY Medicaid |
$3,014.97
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 6
|
Facility
|
IP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 6
|
Facility
|
OP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem Medicaid |
$3,014.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Humana KY Medicaid |
$3,014.97
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 7
|
Facility
|
OP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem Medicaid |
$3,014.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Humana KY Medicaid |
$3,014.97
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 7
|
Facility
|
IP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 8
|
Facility
|
OP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem Medicaid |
$3,014.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Humana KY Medicaid |
$3,014.97
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
