|
LEVOTHYROXINE 25mcg CAPSULE
|
Facility
|
IP
|
$12.23
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Aetna Commercial |
$9.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.54
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cigna Commercial |
$10.15
|
| Rate for Payer: First Health Commercial |
$11.62
|
| Rate for Payer: Humana Commercial |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.76
|
| Rate for Payer: Ohio Health Group HMO |
$9.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.44
|
| Rate for Payer: PHCS Commercial |
$11.74
|
| Rate for Payer: United Healthcare All Payer |
$10.76
|
|
|
LEVOTHYROXINE 25mcg CAPSULE
|
Facility
|
OP
|
$12.23
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Aetna Commercial |
$9.42
|
| Rate for Payer: Anthem Medicaid |
$4.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.54
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Cigna Commercial |
$10.15
|
| Rate for Payer: First Health Commercial |
$11.62
|
| Rate for Payer: Humana Commercial |
$10.40
|
| Rate for Payer: Humana KY Medicaid |
$4.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.76
|
| Rate for Payer: Ohio Health Group HMO |
$9.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.44
|
| Rate for Payer: PHCS Commercial |
$11.74
|
| Rate for Payer: United Healthcare All Payer |
$10.76
|
|
|
LEVSIN (HYOSCYAMINE 0.125MG/1T
|
Facility
|
OP
|
$4.88
|
|
|
Service Code
|
NDC 47781001101
|
| Hospital Charge Code |
25000863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Anthem Medicaid |
$1.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.05
|
| Rate for Payer: First Health Commercial |
$4.64
|
| Rate for Payer: Humana Commercial |
$4.15
|
| Rate for Payer: Humana KY Medicaid |
$1.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.37
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
LEVSIN (HYOSCYAMINE 0.125MG/1T
|
Facility
|
IP
|
$4.88
|
|
|
Service Code
|
NDC 47781001101
|
| Hospital Charge Code |
25000863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.05
|
| Rate for Payer: First Health Commercial |
$4.64
|
| Rate for Payer: Humana Commercial |
$4.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.37
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
LEXAPRO (ESCITA OXALA) 10 MG T
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 904642661
|
| Hospital Charge Code |
25000865
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
LEXAPRO (ESCITA OXALA) 10 MG T
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 904642661
|
| Hospital Charge Code |
25000865
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
LEXISCAN 0.1MG(0.4MG/5ML SYR
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
25002340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$121.92 |
| Rate for Payer: Aetna Commercial |
$97.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.06
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$105.41
|
| Rate for Payer: First Health Commercial |
$120.65
|
| Rate for Payer: Humana Commercial |
$107.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.76
|
| Rate for Payer: Ohio Health Group HMO |
$95.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.63
|
| Rate for Payer: PHCS Commercial |
$121.92
|
| Rate for Payer: United Healthcare All Payer |
$111.76
|
|
|
LEXISCAN 0.1MG(0.4MG/5ML SYR
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
25002340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$121.92 |
| Rate for Payer: Aetna Commercial |
$97.79
|
| Rate for Payer: Anthem Medicaid |
$43.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.06
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$105.41
|
| Rate for Payer: First Health Commercial |
$120.65
|
| Rate for Payer: Humana Commercial |
$107.95
|
| Rate for Payer: Humana KY Medicaid |
$43.68
|
| Rate for Payer: Kentucky WC Medicaid |
$44.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.76
|
| Rate for Payer: Ohio Health Group HMO |
$95.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.63
|
| Rate for Payer: PHCS Commercial |
$121.92
|
| Rate for Payer: United Healthcare All Payer |
$111.76
|
|
|
LFIT ANATOMIC X3 LINER 36D
|
Facility
|
OP
|
$7,933.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.91 |
| Max. Negotiated Rate |
$7,615.73 |
| Rate for Payer: Aetna Commercial |
$6,108.45
|
| Rate for Payer: Anthem Medicaid |
$2,728.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,187.78
|
| Rate for Payer: Cash Price |
$3,966.52
|
| Rate for Payer: Cigna Commercial |
$6,584.43
|
| Rate for Payer: First Health Commercial |
$7,536.40
|
| Rate for Payer: Humana Commercial |
$6,743.09
|
| Rate for Payer: Humana KY Medicaid |
$2,728.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,755.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,505.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,854.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,379.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,782.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,981.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,949.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,346.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,901.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,473.80
|
| Rate for Payer: PHCS Commercial |
$7,615.73
|
| Rate for Payer: United Healthcare All Payer |
$6,981.08
|
|
|
LFIT ANATOMIC X3 LINER 36D
|
Facility
|
IP
|
$7,933.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.91 |
| Max. Negotiated Rate |
$7,615.73 |
| Rate for Payer: Aetna Commercial |
$6,108.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,187.78
|
| Rate for Payer: Cash Price |
$3,966.52
|
| Rate for Payer: Cigna Commercial |
$6,584.43
|
| Rate for Payer: First Health Commercial |
$7,536.40
|
| Rate for Payer: Humana Commercial |
$6,743.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,505.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,854.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,379.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,981.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,949.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,346.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,901.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,473.80
|
| Rate for Payer: PHCS Commercial |
$7,615.73
|
| Rate for Payer: United Healthcare All Payer |
$6,981.08
|
|
|
LFIT ANATOMIC X3 LINER 40E
|
Facility
|
OP
|
$9,315.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,794.79 |
| Max. Negotiated Rate |
$8,943.32 |
| Rate for Payer: Aetna Commercial |
$7,173.29
|
| Rate for Payer: Anthem Medicaid |
$3,203.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,266.45
|
| Rate for Payer: Cash Price |
$4,657.98
|
| Rate for Payer: Cigna Commercial |
$7,732.25
|
| Rate for Payer: First Health Commercial |
$8,850.16
|
| Rate for Payer: Humana Commercial |
$7,918.57
|
| Rate for Payer: Humana KY Medicaid |
$3,203.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,236.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,639.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,875.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,268.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,198.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,452.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,104.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,428.01
|
| Rate for Payer: PHCS Commercial |
$8,943.32
|
| Rate for Payer: United Healthcare All Payer |
$8,198.04
|
|
|
LFIT ANATOMIC X3 LINER 40E
|
Facility
|
IP
|
$9,315.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,794.79 |
| Max. Negotiated Rate |
$8,943.32 |
| Rate for Payer: Aetna Commercial |
$7,173.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,266.45
|
| Rate for Payer: Cash Price |
$4,657.98
|
| Rate for Payer: Cigna Commercial |
$7,732.25
|
| Rate for Payer: First Health Commercial |
$8,850.16
|
| Rate for Payer: Humana Commercial |
$7,918.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,639.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,875.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,198.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,452.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,104.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,428.01
|
| Rate for Payer: PHCS Commercial |
$8,943.32
|
| Rate for Payer: United Healthcare All Payer |
$8,198.04
|
|
|
LFIT ANATOMIC X3 LINER 44F
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem Medicaid |
$3,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Humana KY Medicaid |
$3,291.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
LFIT ANATOMIC X3 LINER 44F
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
LFIT ANATOMIC X3 LINER 44G
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
LFIT ANATOMIC X3 LINER 44G
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem Medicaid |
$3,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Humana KY Medicaid |
$3,291.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
LFIT ANTOMC X3 LINR 44I 8.6MM
|
Facility
|
IP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
LFIT ANTOMC X3 LINR 44I 8.6MM
|
Facility
|
OP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem Medicaid |
$3,854.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Humana KY Medicaid |
$3,854.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,893.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,931.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
LFIT ANTOMC X3 LINR 44J 10.6M
|
Facility
|
IP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
LFIT ANTOMC X3 LINR 44J 10.6M
|
Facility
|
OP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem Medicaid |
$3,854.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Humana KY Medicaid |
$3,854.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,893.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,931.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
LGCY-LPS-MBLE ART SURF SZGX10M
|
Facility
|
IP
|
$7,743.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.06 |
| Max. Negotiated Rate |
$7,433.80 |
| Rate for Payer: Aetna Commercial |
$5,962.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,039.96
|
| Rate for Payer: Cash Price |
$3,871.77
|
| Rate for Payer: Cigna Commercial |
$6,427.14
|
| Rate for Payer: First Health Commercial |
$7,356.36
|
| Rate for Payer: Humana Commercial |
$6,582.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,349.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,714.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,814.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,807.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,194.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,736.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,343.04
|
| Rate for Payer: PHCS Commercial |
$7,433.80
|
| Rate for Payer: United Healthcare All Payer |
$6,814.32
|
|
|
LGCY-LPS-MBLE ART SURF SZGX10M
|
Facility
|
OP
|
$7,743.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.06 |
| Max. Negotiated Rate |
$7,433.80 |
| Rate for Payer: Aetna Commercial |
$5,962.53
|
| Rate for Payer: Anthem Medicaid |
$2,663.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,039.96
|
| Rate for Payer: Cash Price |
$3,871.77
|
| Rate for Payer: Cigna Commercial |
$6,427.14
|
| Rate for Payer: First Health Commercial |
$7,356.36
|
| Rate for Payer: Humana Commercial |
$6,582.01
|
| Rate for Payer: Humana KY Medicaid |
$2,663.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,349.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,714.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,814.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,807.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,194.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,736.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,343.04
|
| Rate for Payer: PHCS Commercial |
$7,433.80
|
| Rate for Payer: United Healthcare All Payer |
$6,814.32
|
|
|
LGCY PSTSTB LPS-FLX FM CMSZGRT
|
Facility
|
OP
|
$17,855.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.63 |
| Max. Negotiated Rate |
$17,141.20 |
| Rate for Payer: Aetna Commercial |
$13,748.67
|
| Rate for Payer: Anthem Medicaid |
$6,140.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,927.23
|
| Rate for Payer: Cash Price |
$8,927.71
|
| Rate for Payer: Cigna Commercial |
$14,820.00
|
| Rate for Payer: First Health Commercial |
$16,962.65
|
| Rate for Payer: Humana Commercial |
$15,177.11
|
| Rate for Payer: Humana KY Medicaid |
$6,140.48
|
| Rate for Payer: Kentucky WC Medicaid |
$6,202.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,641.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,177.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,263.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,712.77
|
| Rate for Payer: Ohio Health Group HMO |
$13,391.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,284.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,534.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,320.24
|
| Rate for Payer: PHCS Commercial |
$17,141.20
|
| Rate for Payer: United Healthcare All Payer |
$15,712.77
|
|
|
LGCY PSTSTB LPS-FLX FM CMSZGRT
|
Facility
|
IP
|
$17,855.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.63 |
| Max. Negotiated Rate |
$17,141.20 |
| Rate for Payer: Aetna Commercial |
$13,748.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,927.23
|
| Rate for Payer: Cash Price |
$8,927.71
|
| Rate for Payer: Cigna Commercial |
$14,820.00
|
| Rate for Payer: First Health Commercial |
$16,962.65
|
| Rate for Payer: Humana Commercial |
$15,177.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,641.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,177.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,712.77
|
| Rate for Payer: Ohio Health Group HMO |
$13,391.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,284.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,534.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,320.24
|
| Rate for Payer: PHCS Commercial |
$17,141.20
|
| Rate for Payer: United Healthcare All Payer |
$15,712.77
|
|
|
LG DRES/OR DETRI BURN W/O ANES
|
Facility
|
OP
|
$172.00
|
|
| Hospital Charge Code |
76102560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$59.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$59.15
|
| Rate for Payer: Kentucky WC Medicaid |
$59.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
