|
INVIS DIST CENT SZ 16MM
|
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 16MM
|
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 17MM
|
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 17MM
|
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 18MM
|
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 18MM
|
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 19MM
|
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 19MM
|
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 20MM
|
Facility
|
OP
|
$1,572.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.89 |
| Max. Negotiated Rate |
$1,510.05 |
| Rate for Payer: Aetna Commercial |
$1,211.19
|
| Rate for Payer: Anthem Medicaid |
$540.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.92
|
| Rate for Payer: Cash Price |
$786.48
|
| Rate for Payer: Cigna Commercial |
$1,305.57
|
| Rate for Payer: First Health Commercial |
$1,494.32
|
| Rate for Payer: Humana Commercial |
$1,337.02
|
| Rate for Payer: Humana KY Medicaid |
$540.94
|
| Rate for Payer: Kentucky WC Medicaid |
$546.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$551.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,384.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,258.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,368.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.35
|
| Rate for Payer: PHCS Commercial |
$1,510.05
|
| Rate for Payer: United Healthcare All Payer |
$1,384.21
|
|
|
INVIS DIST CENT SZ 20MM
|
Facility
|
IP
|
$1,572.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.89 |
| Max. Negotiated Rate |
$1,510.05 |
| Rate for Payer: Aetna Commercial |
$1,211.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.92
|
| Rate for Payer: Cash Price |
$786.48
|
| Rate for Payer: Cigna Commercial |
$1,305.57
|
| Rate for Payer: First Health Commercial |
$1,494.32
|
| Rate for Payer: Humana Commercial |
$1,337.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,384.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,258.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,368.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.35
|
| Rate for Payer: PHCS Commercial |
$1,510.05
|
| Rate for Payer: United Healthcare All Payer |
$1,384.21
|
|
|
INVIS DIST CENT SZ 21MM
|
Facility
|
OP
|
$1,572.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.89 |
| Max. Negotiated Rate |
$1,510.05 |
| Rate for Payer: Aetna Commercial |
$1,211.19
|
| Rate for Payer: Anthem Medicaid |
$540.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.92
|
| Rate for Payer: Cash Price |
$786.48
|
| Rate for Payer: Cigna Commercial |
$1,305.57
|
| Rate for Payer: First Health Commercial |
$1,494.32
|
| Rate for Payer: Humana Commercial |
$1,337.02
|
| Rate for Payer: Humana KY Medicaid |
$540.94
|
| Rate for Payer: Kentucky WC Medicaid |
$546.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$551.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,384.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,258.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,368.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.35
|
| Rate for Payer: PHCS Commercial |
$1,510.05
|
| Rate for Payer: United Healthcare All Payer |
$1,384.21
|
|
|
INVIS DIST CENT SZ 21MM
|
Facility
|
IP
|
$1,572.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.89 |
| Max. Negotiated Rate |
$1,510.05 |
| Rate for Payer: Aetna Commercial |
$1,211.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.92
|
| Rate for Payer: Cash Price |
$786.48
|
| Rate for Payer: Cigna Commercial |
$1,305.57
|
| Rate for Payer: First Health Commercial |
$1,494.32
|
| Rate for Payer: Humana Commercial |
$1,337.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,384.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,258.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,368.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.35
|
| Rate for Payer: PHCS Commercial |
$1,510.05
|
| Rate for Payer: United Healthcare All Payer |
$1,384.21
|
|
|
INVIS DIST CENT SZ 8MM
|
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 8MM
|
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 9MM
|
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 9MM
|
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
|
|
|
INVOKANA 100MG TABLET
|
Facility
|
OP
|
$36.95
|
|
|
Service Code
|
NDC 50458014030
|
| Hospital Charge Code |
25000791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$35.47 |
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Anthem Medicaid |
$12.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.82
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cigna Commercial |
$30.67
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: Humana Commercial |
$31.41
|
| Rate for Payer: Humana KY Medicaid |
$12.71
|
| Rate for Payer: Kentucky WC Medicaid |
$12.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.52
|
| Rate for Payer: Ohio Health Group HMO |
$27.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.50
|
| Rate for Payer: PHCS Commercial |
$35.47
|
| Rate for Payer: United Healthcare All Payer |
$32.52
|
|
|
INVOKANA 100MG TABLET
|
Facility
|
IP
|
$36.95
|
|
|
Service Code
|
NDC 50458014030
|
| Hospital Charge Code |
25000791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$35.47 |
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.82
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cigna Commercial |
$30.67
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: Humana Commercial |
$31.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.52
|
| Rate for Payer: Ohio Health Group HMO |
$27.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.50
|
| Rate for Payer: PHCS Commercial |
$35.47
|
| Rate for Payer: United Healthcare All Payer |
$32.52
|
|
|
INVOKANA 300 MG TABLET
|
Facility
|
OP
|
$36.95
|
|
|
Service Code
|
NDC 50458014130
|
| Hospital Charge Code |
25000792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$35.47 |
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Anthem Medicaid |
$12.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.82
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cigna Commercial |
$30.67
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: Humana Commercial |
$31.41
|
| Rate for Payer: Humana KY Medicaid |
$12.71
|
| Rate for Payer: Kentucky WC Medicaid |
$12.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.52
|
| Rate for Payer: Ohio Health Group HMO |
$27.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.50
|
| Rate for Payer: PHCS Commercial |
$35.47
|
| Rate for Payer: United Healthcare All Payer |
$32.52
|
|
|
INVOKANA 300 MG TABLET
|
Facility
|
IP
|
$36.95
|
|
|
Service Code
|
NDC 50458014130
|
| Hospital Charge Code |
25000792
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$35.47 |
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.82
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cigna Commercial |
$30.67
|
| Rate for Payer: First Health Commercial |
$35.10
|
| Rate for Payer: Humana Commercial |
$31.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.52
|
| Rate for Payer: Ohio Health Group HMO |
$27.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.50
|
| Rate for Payer: PHCS Commercial |
$35.47
|
| Rate for Payer: United Healthcare All Payer |
$32.52
|
|
|
IOD I131 SODIOD CAPTHER EAMLCR
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
340T0053
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$17.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.23
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Humana KY Medicaid |
$17.54
|
| Rate for Payer: Humana Medicare Advantage |
$23.13
|
| Rate for Payer: Kentucky WC Medicaid |
$17.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
IOD I131 SODIOD CAPTHER EAMLCR
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34000053
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$17.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.23
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Humana KY Medicaid |
$17.54
|
| Rate for Payer: Humana Medicare Advantage |
$23.13
|
| Rate for Payer: Kentucky WC Medicaid |
$17.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
IOD I131 SODIOD CAPTHER EAMLCR
|
Professional
|
Both
|
$51.00
|
|
| Hospital Charge Code |
34000053
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Multiplan PHCS |
$30.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.70
|
| Rate for Payer: UHCCP Medicaid |
$17.85
|
|
|
IOD I131 SODIOD CAPTHER EAMLCR
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
340T0053
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.78
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
IOD I131 SODIOD CAPTHER EAMLCR
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS A9517
|
| Hospital Charge Code |
34000053
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.78
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
