|
INVEGA TRINZA 1mg (546mg Syr)
|
Facility
|
IP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1mg (546mg Syr)
|
Professional
|
Both
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Ambetter Exchange |
$12.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.55
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.96
|
| Rate for Payer: Multiplan PHCS |
$42.53
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16.85
|
| Rate for Payer: UHCCP Medicaid |
$24.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.96
|
|
|
INVEGA TRINZA 1mg (546mg Syr)
|
Facility
|
IP
|
$38,904.66
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002295
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,671.40 |
| Max. Negotiated Rate |
$37,348.47 |
| Rate for Payer: Aetna Commercial |
$29,956.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,345.63
|
| Rate for Payer: Cash Price |
$19,452.33
|
| Rate for Payer: Cigna Commercial |
$32,290.87
|
| Rate for Payer: First Health Commercial |
$36,959.43
|
| Rate for Payer: Humana Commercial |
$33,068.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,901.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,711.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,671.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,236.10
|
| Rate for Payer: Ohio Health Group HMO |
$29,178.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,123.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,847.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,844.22
|
| Rate for Payer: PHCS Commercial |
$37,348.47
|
| Rate for Payer: United Healthcare All Payer |
$34,236.10
|
|
|
INVEGA TRINZA 1mg (546mg Syr)
|
Facility
|
OP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem Medicaid |
$24.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Humana KY Medicaid |
$24.38
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1mg (546mg Syr)
|
Facility
|
IP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1mg (546mg Syr)
|
Facility
|
OP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem Medicaid |
$24.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Humana KY Medicaid |
$24.38
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Professional
|
Both
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Ambetter Exchange |
$12.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.55
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.96
|
| Rate for Payer: Multiplan PHCS |
$42.53
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16.85
|
| Rate for Payer: UHCCP Medicaid |
$24.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.96
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Facility
|
OP
|
$58,244.64
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$55,914.85 |
| Rate for Payer: Aetna Commercial |
$44,848.37
|
| Rate for Payer: Anthem Medicaid |
$20,030.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45,430.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$29,122.32
|
| Rate for Payer: Cash Price |
$29,122.32
|
| Rate for Payer: Cigna Commercial |
$48,343.05
|
| Rate for Payer: First Health Commercial |
$55,332.41
|
| Rate for Payer: Humana Commercial |
$49,507.94
|
| Rate for Payer: Humana KY Medicaid |
$20,030.33
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$20,234.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47,760.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42,984.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,432.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$51,255.28
|
| Rate for Payer: Ohio Health Group HMO |
$43,683.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46,595.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50,672.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40,188.80
|
| Rate for Payer: PHCS Commercial |
$55,914.85
|
| Rate for Payer: United Healthcare All Payer |
$51,255.28
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Facility
|
IP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Facility
|
OP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem Medicaid |
$24.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Humana KY Medicaid |
$24.38
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Facility
|
OP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
636T0055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem Medicaid |
$24.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Humana KY Medicaid |
$24.38
|
| Rate for Payer: Humana Medicare Advantage |
$12.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Facility
|
IP
|
$70.89
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
63600055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.29
|
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Cigna Commercial |
$58.84
|
| Rate for Payer: First Health Commercial |
$67.35
|
| Rate for Payer: Humana Commercial |
$60.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.38
|
| Rate for Payer: Ohio Health Group HMO |
$53.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.91
|
| Rate for Payer: PHCS Commercial |
$68.05
|
| Rate for Payer: United Healthcare All Payer |
$62.38
|
|
|
INVEGA TRINZA 1MG (819MG SYR)
|
Facility
|
IP
|
$58,244.64
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
25002296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17,473.39 |
| Max. Negotiated Rate |
$55,914.85 |
| Rate for Payer: Aetna Commercial |
$44,848.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45,430.82
|
| Rate for Payer: Cash Price |
$29,122.32
|
| Rate for Payer: Cigna Commercial |
$48,343.05
|
| Rate for Payer: First Health Commercial |
$55,332.41
|
| Rate for Payer: Humana Commercial |
$49,507.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47,760.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42,984.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,473.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$51,255.28
|
| Rate for Payer: Ohio Health Group HMO |
$43,683.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46,595.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50,672.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40,188.80
|
| Rate for Payer: PHCS Commercial |
$55,914.85
|
| Rate for Payer: United Healthcare All Payer |
$51,255.28
|
|
|
INVIS DIST CENT SZ 10MM
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.70 |
| Max. Negotiated Rate |
$1,698.24 |
| Rate for Payer: Aetna Commercial |
$1,362.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.82
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cigna Commercial |
$1,468.27
|
| Rate for Payer: First Health Commercial |
$1,680.55
|
| Rate for Payer: Humana Commercial |
$1,503.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,415.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.61
|
| Rate for Payer: PHCS Commercial |
$1,698.24
|
| Rate for Payer: United Healthcare All Payer |
$1,556.72
|
|
|
INVIS DIST CENT SZ 10MM
|
Facility
|
OP
|
$1,769.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.70 |
| Max. Negotiated Rate |
$1,698.24 |
| Rate for Payer: Aetna Commercial |
$1,362.13
|
| Rate for Payer: Anthem Medicaid |
$608.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.82
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cigna Commercial |
$1,468.27
|
| Rate for Payer: First Health Commercial |
$1,680.55
|
| Rate for Payer: Humana Commercial |
$1,503.65
|
| Rate for Payer: Humana KY Medicaid |
$608.36
|
| Rate for Payer: Kentucky WC Medicaid |
$614.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,415.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.61
|
| Rate for Payer: PHCS Commercial |
$1,698.24
|
| Rate for Payer: United Healthcare All Payer |
$1,556.72
|
|
|
INVIS DIST CENT SZ 11MM
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
INVIS DIST CENT SZ 11MM
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
INVIS DIST CENT SZ 12MM
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
INVIS DIST CENT SZ 12MM
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
INVIS DIST CENT SZ 13MM
|
Facility
|
OP
|
$1,787.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.32 |
| Max. Negotiated Rate |
$1,716.22 |
| Rate for Payer: Aetna Commercial |
$1,376.55
|
| Rate for Payer: Anthem Medicaid |
$614.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.43
|
| Rate for Payer: Cash Price |
$893.86
|
| Rate for Payer: Cigna Commercial |
$1,483.82
|
| Rate for Payer: First Health Commercial |
$1,698.34
|
| Rate for Payer: Humana Commercial |
$1,519.57
|
| Rate for Payer: Humana KY Medicaid |
$614.80
|
| Rate for Payer: Kentucky WC Medicaid |
$621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.53
|
| Rate for Payer: PHCS Commercial |
$1,716.22
|
| Rate for Payer: United Healthcare All Payer |
$1,573.20
|
|
|
INVIS DIST CENT SZ 13MM
|
Facility
|
IP
|
$1,787.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.32 |
| Max. Negotiated Rate |
$1,716.22 |
| Rate for Payer: Aetna Commercial |
$1,376.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.43
|
| Rate for Payer: Cash Price |
$893.86
|
| Rate for Payer: Cigna Commercial |
$1,483.82
|
| Rate for Payer: First Health Commercial |
$1,698.34
|
| Rate for Payer: Humana Commercial |
$1,519.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.53
|
| Rate for Payer: PHCS Commercial |
$1,716.22
|
| Rate for Payer: United Healthcare All Payer |
$1,573.20
|
|
|
INVIS DIST CENT SZ 14MM
|
Facility
|
IP
|
$1,787.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.32 |
| Max. Negotiated Rate |
$1,716.22 |
| Rate for Payer: Aetna Commercial |
$1,376.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.43
|
| Rate for Payer: Cash Price |
$893.86
|
| Rate for Payer: Cigna Commercial |
$1,483.82
|
| Rate for Payer: First Health Commercial |
$1,698.34
|
| Rate for Payer: Humana Commercial |
$1,519.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.53
|
| Rate for Payer: PHCS Commercial |
$1,716.22
|
| Rate for Payer: United Healthcare All Payer |
$1,573.20
|
|
|
INVIS DIST CENT SZ 14MM
|
Facility
|
OP
|
$1,787.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.32 |
| Max. Negotiated Rate |
$1,716.22 |
| Rate for Payer: Aetna Commercial |
$1,376.55
|
| Rate for Payer: Anthem Medicaid |
$614.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.43
|
| Rate for Payer: Cash Price |
$893.86
|
| Rate for Payer: Cigna Commercial |
$1,483.82
|
| Rate for Payer: First Health Commercial |
$1,698.34
|
| Rate for Payer: Humana Commercial |
$1,519.57
|
| Rate for Payer: Humana KY Medicaid |
$614.80
|
| Rate for Payer: Kentucky WC Medicaid |
$621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.53
|
| Rate for Payer: PHCS Commercial |
$1,716.22
|
| Rate for Payer: United Healthcare All Payer |
$1,573.20
|
|
|
INVIS DIST CENT SZ 15MM
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
INVIS DIST CENT SZ 15MM
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
