|
INVEGA TRINZA 1mg (546mg Syr)
|
Facility
|
IP
|
$37,918.76
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002295
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,929.44 |
| Max. Negotiated Rate |
$36,402.01 |
| Rate for Payer: Aetna Commercial |
$29,197.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,576.63
|
| Rate for Payer: Cash Price |
$18,959.38
|
| Rate for Payer: Cigna Commercial |
$31,472.57
|
| Rate for Payer: First Health Commercial |
$36,022.82
|
| Rate for Payer: Humana Commercial |
$32,230.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,093.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,984.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,375.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,368.51
|
| Rate for Payer: Ohio Health Group HMO |
$28,439.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,583.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,929.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,754.82
|
| Rate for Payer: PHCS Commercial |
$36,402.01
|
| Rate for Payer: United Healthcare All Payer |
$33,368.51
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Facility
|
IP
|
$59.48
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna Commercial |
$45.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.39
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cigna Commercial |
$49.37
|
| Rate for Payer: First Health Commercial |
$56.51
|
| Rate for Payer: Humana Commercial |
$50.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.34
|
| Rate for Payer: Ohio Health Group HMO |
$44.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.44
|
| Rate for Payer: PHCS Commercial |
$57.10
|
| Rate for Payer: United Healthcare All Payer |
$52.34
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Facility
|
IP
|
$59.48
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna Commercial |
$45.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.39
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cigna Commercial |
$49.37
|
| Rate for Payer: First Health Commercial |
$56.51
|
| Rate for Payer: Humana Commercial |
$50.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.34
|
| Rate for Payer: Ohio Health Group HMO |
$44.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.44
|
| Rate for Payer: PHCS Commercial |
$57.10
|
| Rate for Payer: United Healthcare All Payer |
$52.34
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Facility
|
OP
|
$59.48
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna Commercial |
$45.80
|
| Rate for Payer: Anthem Medicaid |
$20.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cigna Commercial |
$49.37
|
| Rate for Payer: First Health Commercial |
$56.51
|
| Rate for Payer: Humana Commercial |
$50.56
|
| Rate for Payer: Humana KY Medicaid |
$20.46
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Kentucky WC Medicaid |
$20.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.34
|
| Rate for Payer: Ohio Health Group HMO |
$44.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.44
|
| Rate for Payer: PHCS Commercial |
$57.10
|
| Rate for Payer: United Healthcare All Payer |
$52.34
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Facility
|
IP
|
$56,768.62
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,379.92 |
| Max. Negotiated Rate |
$54,497.88 |
| Rate for Payer: Aetna Commercial |
$43,711.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44,279.52
|
| Rate for Payer: Cash Price |
$28,384.31
|
| Rate for Payer: Cigna Commercial |
$47,117.95
|
| Rate for Payer: First Health Commercial |
$53,930.19
|
| Rate for Payer: Humana Commercial |
$48,253.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46,550.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41,895.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,030.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$49,956.39
|
| Rate for Payer: Ohio Health Group HMO |
$42,576.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,353.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,379.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,598.27
|
| Rate for Payer: PHCS Commercial |
$54,497.88
|
| Rate for Payer: United Healthcare All Payer |
$49,956.39
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Professional
|
Both
|
$59.48
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$59.48 |
| Rate for Payer: Buckeye Medicare Advantage |
$59.48
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Multiplan PHCS |
$35.69
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.64
|
| Rate for Payer: UHCCP Medicaid |
$20.82
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Facility
|
OP
|
$59.48
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna Commercial |
$45.80
|
| Rate for Payer: Anthem Medicaid |
$20.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cigna Commercial |
$49.37
|
| Rate for Payer: First Health Commercial |
$56.51
|
| Rate for Payer: Humana Commercial |
$50.56
|
| Rate for Payer: Humana KY Medicaid |
$20.46
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Kentucky WC Medicaid |
$20.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.34
|
| Rate for Payer: Ohio Health Group HMO |
$44.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.44
|
| Rate for Payer: PHCS Commercial |
$57.10
|
| Rate for Payer: United Healthcare All Payer |
$52.34
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Facility
|
OP
|
$56,768.62
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$54,497.88 |
| Rate for Payer: Aetna Commercial |
$43,711.84
|
| Rate for Payer: Anthem Medicaid |
$19,522.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44,279.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.48
|
| Rate for Payer: Cash Price |
$28,384.31
|
| Rate for Payer: Cash Price |
$28,384.31
|
| Rate for Payer: Cigna Commercial |
$47,117.95
|
| Rate for Payer: First Health Commercial |
$53,930.19
|
| Rate for Payer: Humana Commercial |
$48,253.33
|
| Rate for Payer: Humana KY Medicaid |
$19,522.73
|
| Rate for Payer: Humana Medicare Advantage |
$12.21
|
| Rate for Payer: Kentucky WC Medicaid |
$19,721.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46,550.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41,895.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,914.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$49,956.39
|
| Rate for Payer: Ohio Health Group HMO |
$42,576.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,353.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,379.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,598.27
|
| Rate for Payer: PHCS Commercial |
$54,497.88
|
| Rate for Payer: United Healthcare All Payer |
$49,956.39
|
|
|
INVIS DIST CENT SZ 10MM
|
Facility
|
IP
|
$1,781.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.66 |
| Max. Negotiated Rate |
$1,710.69 |
| Rate for Payer: Aetna Commercial |
$1,372.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,389.94
|
| Rate for Payer: Cash Price |
$890.98
|
| Rate for Payer: Cigna Commercial |
$1,479.04
|
| Rate for Payer: First Health Commercial |
$1,692.87
|
| Rate for Payer: Humana Commercial |
$1,514.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.41
|
| Rate for Payer: PHCS Commercial |
$1,710.69
|
| Rate for Payer: United Healthcare All Payer |
$1,568.13
|
|
|
INVIS DIST CENT SZ 10MM
|
Facility
|
OP
|
$1,781.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.66 |
| Max. Negotiated Rate |
$1,710.69 |
| Rate for Payer: Aetna Commercial |
$1,372.12
|
| Rate for Payer: Anthem Medicaid |
$612.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,389.94
|
| Rate for Payer: Cash Price |
$890.98
|
| Rate for Payer: Cigna Commercial |
$1,479.04
|
| Rate for Payer: First Health Commercial |
$1,692.87
|
| Rate for Payer: Humana Commercial |
$1,514.67
|
| Rate for Payer: Humana KY Medicaid |
$612.82
|
| Rate for Payer: Kentucky WC Medicaid |
$619.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.41
|
| Rate for Payer: PHCS Commercial |
$1,710.69
|
| Rate for Payer: United Healthcare All Payer |
$1,568.13
|
|
|
INVIS DIST CENT SZ 11MM
|
Facility
|
IP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
INVIS DIST CENT SZ 11MM
|
Facility
|
OP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem Medicaid |
$275.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Humana KY Medicaid |
$275.98
|
| Rate for Payer: Kentucky WC Medicaid |
$278.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
INVIS DIST CENT SZ 12MM
|
Facility
|
IP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
INVIS DIST CENT SZ 12MM
|
Facility
|
OP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem Medicaid |
$275.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Humana KY Medicaid |
$275.98
|
| Rate for Payer: Kentucky WC Medicaid |
$278.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
INVIS DIST CENT SZ 13MM
|
Facility
|
OP
|
$1,799.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.90 |
| Max. Negotiated Rate |
$1,727.25 |
| Rate for Payer: Aetna Commercial |
$1,385.40
|
| Rate for Payer: Anthem Medicaid |
$618.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.39
|
| Rate for Payer: Cash Price |
$899.61
|
| Rate for Payer: Cigna Commercial |
$1,493.35
|
| Rate for Payer: First Health Commercial |
$1,709.26
|
| Rate for Payer: Humana Commercial |
$1,529.34
|
| Rate for Payer: Humana KY Medicaid |
$618.75
|
| Rate for Payer: Kentucky WC Medicaid |
$625.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,327.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.76
|
| Rate for Payer: PHCS Commercial |
$1,727.25
|
| Rate for Payer: United Healthcare All Payer |
$1,583.31
|
|
|
INVIS DIST CENT SZ 13MM
|
Facility
|
IP
|
$1,799.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.90 |
| Max. Negotiated Rate |
$1,727.25 |
| Rate for Payer: Aetna Commercial |
$1,385.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.39
|
| Rate for Payer: Cash Price |
$899.61
|
| Rate for Payer: Cigna Commercial |
$1,493.35
|
| Rate for Payer: First Health Commercial |
$1,709.26
|
| Rate for Payer: Humana Commercial |
$1,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,327.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.76
|
| Rate for Payer: PHCS Commercial |
$1,727.25
|
| Rate for Payer: United Healthcare All Payer |
$1,583.31
|
|
|
INVIS DIST CENT SZ 14MM
|
Facility
|
OP
|
$1,799.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.90 |
| Max. Negotiated Rate |
$1,727.25 |
| Rate for Payer: Aetna Commercial |
$1,385.40
|
| Rate for Payer: Anthem Medicaid |
$618.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.39
|
| Rate for Payer: Cash Price |
$899.61
|
| Rate for Payer: Cigna Commercial |
$1,493.35
|
| Rate for Payer: First Health Commercial |
$1,709.26
|
| Rate for Payer: Humana Commercial |
$1,529.34
|
| Rate for Payer: Humana KY Medicaid |
$618.75
|
| Rate for Payer: Kentucky WC Medicaid |
$625.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,327.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.76
|
| Rate for Payer: PHCS Commercial |
$1,727.25
|
| Rate for Payer: United Healthcare All Payer |
$1,583.31
|
|
|
INVIS DIST CENT SZ 14MM
|
Facility
|
IP
|
$1,799.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.90 |
| Max. Negotiated Rate |
$1,727.25 |
| Rate for Payer: Aetna Commercial |
$1,385.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.39
|
| Rate for Payer: Cash Price |
$899.61
|
| Rate for Payer: Cigna Commercial |
$1,493.35
|
| Rate for Payer: First Health Commercial |
$1,709.26
|
| Rate for Payer: Humana Commercial |
$1,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,327.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.76
|
| Rate for Payer: PHCS Commercial |
$1,727.25
|
| Rate for Payer: United Healthcare All Payer |
$1,583.31
|
|
|
INVIS DIST CENT SZ 15MM
|
Facility
|
OP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem Medicaid |
$275.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Humana KY Medicaid |
$275.98
|
| Rate for Payer: Kentucky WC Medicaid |
$278.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
INVIS DIST CENT SZ 15MM
|
Facility
|
IP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
INVIS DIST CENT SZ 16MM
|
Facility
|
OP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem Medicaid |
$275.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Humana KY Medicaid |
$275.98
|
| Rate for Payer: Kentucky WC Medicaid |
$278.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
INVIS DIST CENT SZ 16MM
|
Facility
|
IP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
INVIS DIST CENT SZ 17MM
|
Facility
|
IP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
INVIS DIST CENT SZ 17MM
|
Facility
|
OP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem Medicaid |
$275.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Humana KY Medicaid |
$275.98
|
| Rate for Payer: Kentucky WC Medicaid |
$278.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
INVIS DIST CENT SZ 18MM
|
Facility
|
OP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem Medicaid |
$275.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Humana KY Medicaid |
$275.98
|
| Rate for Payer: Kentucky WC Medicaid |
$278.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
