|
MUCINEX (GUAIFENESIN) 600 MG T
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
25001015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
MUCOMYST 10% 400 MG/4 ML VLSYR
|
Facility
|
IP
|
$27.87
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
25002513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$26.76 |
| Rate for Payer: Aetna Commercial |
$21.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.74
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cigna Commercial |
$23.13
|
| Rate for Payer: First Health Commercial |
$26.48
|
| Rate for Payer: Humana Commercial |
$23.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.53
|
| Rate for Payer: Ohio Health Group HMO |
$20.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.23
|
| Rate for Payer: PHCS Commercial |
$26.76
|
| Rate for Payer: United Healthcare All Payer |
$24.53
|
|
|
MUCOMYST 10% 400 MG/4 ML VLSYR
|
Facility
|
OP
|
$27.87
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
25002513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$26.76 |
| Rate for Payer: Aetna Commercial |
$21.46
|
| Rate for Payer: Anthem Medicaid |
$9.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.74
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Cigna Commercial |
$23.13
|
| Rate for Payer: First Health Commercial |
$26.48
|
| Rate for Payer: Humana Commercial |
$23.69
|
| Rate for Payer: Humana KY Medicaid |
$9.58
|
| Rate for Payer: Kentucky WC Medicaid |
$9.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.53
|
| Rate for Payer: Ohio Health Group HMO |
$20.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.23
|
| Rate for Payer: PHCS Commercial |
$26.76
|
| Rate for Payer: United Healthcare All Payer |
$24.53
|
|
|
MUCOMYST 20% 6 GRAM(30ML)
|
Facility
|
OP
|
$67.65
|
|
|
Service Code
|
NDC 63323069030
|
| Hospital Charge Code |
25003234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$64.94 |
| Rate for Payer: Aetna Commercial |
$52.09
|
| Rate for Payer: Anthem Medicaid |
$23.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.77
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: Cigna Commercial |
$56.15
|
| Rate for Payer: First Health Commercial |
$64.27
|
| Rate for Payer: Humana Commercial |
$57.50
|
| Rate for Payer: Humana KY Medicaid |
$23.26
|
| Rate for Payer: Kentucky WC Medicaid |
$23.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.53
|
| Rate for Payer: Ohio Health Group HMO |
$50.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.68
|
| Rate for Payer: PHCS Commercial |
$64.94
|
| Rate for Payer: United Healthcare All Payer |
$59.53
|
|
|
MUCOMYST 20% 6 GRAM(30ML)
|
Facility
|
IP
|
$67.65
|
|
|
Service Code
|
NDC 63323069030
|
| Hospital Charge Code |
25003234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$64.94 |
| Rate for Payer: Aetna Commercial |
$52.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.77
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: Cigna Commercial |
$56.15
|
| Rate for Payer: First Health Commercial |
$64.27
|
| Rate for Payer: Humana Commercial |
$57.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.53
|
| Rate for Payer: Ohio Health Group HMO |
$50.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.68
|
| Rate for Payer: PHCS Commercial |
$64.94
|
| Rate for Payer: United Healthcare All Payer |
$59.53
|
|
|
MUCOMYST 20%(ACETYLCY)ORAL 3ML
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
25001017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.89
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$9.46
|
| Rate for Payer: First Health Commercial |
$10.83
|
| Rate for Payer: Humana Commercial |
$9.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.03
|
| Rate for Payer: Ohio Health Group HMO |
$8.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.87
|
| Rate for Payer: PHCS Commercial |
$10.94
|
| Rate for Payer: United Healthcare All Payer |
$10.03
|
|
|
MUCOMYST 20%(ACETYLCY)ORAL 3ML
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
25001017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: Anthem Medicaid |
$3.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.89
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$9.46
|
| Rate for Payer: First Health Commercial |
$10.83
|
| Rate for Payer: Humana Commercial |
$9.69
|
| Rate for Payer: Humana KY Medicaid |
$3.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.03
|
| Rate for Payer: Ohio Health Group HMO |
$8.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.87
|
| Rate for Payer: PHCS Commercial |
$10.94
|
| Rate for Payer: United Healthcare All Payer |
$10.03
|
|
|
MUCOMYSTACETYLCYS20% 800MG/4ML
|
Facility
|
OP
|
$79.40
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
25002514
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.82 |
| Max. Negotiated Rate |
$76.22 |
| Rate for Payer: Aetna Commercial |
$61.14
|
| Rate for Payer: Anthem Medicaid |
$27.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.93
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cigna Commercial |
$65.90
|
| Rate for Payer: First Health Commercial |
$75.43
|
| Rate for Payer: Humana Commercial |
$67.49
|
| Rate for Payer: Humana KY Medicaid |
$27.31
|
| Rate for Payer: Kentucky WC Medicaid |
$27.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.87
|
| Rate for Payer: Ohio Health Group HMO |
$59.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.79
|
| Rate for Payer: PHCS Commercial |
$76.22
|
| Rate for Payer: United Healthcare All Payer |
$69.87
|
|
|
MUCOMYSTACETYLCYS20% 800MG/4ML
|
Facility
|
IP
|
$79.40
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
25002514
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.82 |
| Max. Negotiated Rate |
$76.22 |
| Rate for Payer: Aetna Commercial |
$61.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.93
|
| Rate for Payer: Cash Price |
$39.70
|
| Rate for Payer: Cigna Commercial |
$65.90
|
| Rate for Payer: First Health Commercial |
$75.43
|
| Rate for Payer: Humana Commercial |
$67.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.87
|
| Rate for Payer: Ohio Health Group HMO |
$59.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.79
|
| Rate for Payer: PHCS Commercial |
$76.22
|
| Rate for Payer: United Healthcare All Payer |
$69.87
|
|
|
MUGWORT IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000717
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
MUGWORT IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000717
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
MULTAQ 400MG TABLET
|
Facility
|
OP
|
$30.50
|
|
|
Service Code
|
NDC 24414260
|
| Hospital Charge Code |
25001018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$29.28 |
| Rate for Payer: Aetna Commercial |
$23.48
|
| Rate for Payer: Anthem Medicaid |
$10.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.79
|
| Rate for Payer: Cash Price |
$15.25
|
| Rate for Payer: Cigna Commercial |
$25.32
|
| Rate for Payer: First Health Commercial |
$28.98
|
| Rate for Payer: Humana Commercial |
$25.93
|
| Rate for Payer: Humana KY Medicaid |
$10.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.84
|
| Rate for Payer: Ohio Health Group HMO |
$22.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.05
|
| Rate for Payer: PHCS Commercial |
$29.28
|
| Rate for Payer: United Healthcare All Payer |
$26.84
|
|
|
MULTAQ 400MG TABLET
|
Facility
|
IP
|
$30.50
|
|
|
Service Code
|
NDC 24414260
|
| Hospital Charge Code |
25001018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$29.28 |
| Rate for Payer: Aetna Commercial |
$23.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.79
|
| Rate for Payer: Cash Price |
$15.25
|
| Rate for Payer: Cigna Commercial |
$25.32
|
| Rate for Payer: First Health Commercial |
$28.98
|
| Rate for Payer: Humana Commercial |
$25.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.84
|
| Rate for Payer: Ohio Health Group HMO |
$22.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.05
|
| Rate for Payer: PHCS Commercial |
$29.28
|
| Rate for Payer: United Healthcare All Payer |
$26.84
|
|
|
MULTI-LINK 8LL STENT 3*33
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
MULTI-LINK 8LL STENT 3*33
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
MULTI-LINK 8 LL STENT 3*38
|
Facility
|
OP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem Medicaid |
$1,384.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Humana KY Medicaid |
$1,384.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,398.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,411.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
MULTI-LINK 8 LL STENT 3*38
|
Facility
|
IP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
MULTI-LINK 8 LL STENT 3.5*33
|
Facility
|
IP
|
$5,037.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.25 |
| Max. Negotiated Rate |
$4,836.00 |
| Rate for Payer: Aetna Commercial |
$3,878.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.25
|
| Rate for Payer: Cash Price |
$2,518.75
|
| Rate for Payer: Cigna Commercial |
$4,181.12
|
| Rate for Payer: First Health Commercial |
$4,785.62
|
| Rate for Payer: Humana Commercial |
$4,281.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,130.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,717.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,030.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,382.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,475.88
|
| Rate for Payer: PHCS Commercial |
$4,836.00
|
| Rate for Payer: United Healthcare All Payer |
$4,433.00
|
|
|
MULTI-LINK 8 LL STENT 3.5*33
|
Facility
|
OP
|
$5,037.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.25 |
| Max. Negotiated Rate |
$4,836.00 |
| Rate for Payer: Aetna Commercial |
$3,878.88
|
| Rate for Payer: Anthem Medicaid |
$1,732.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.25
|
| Rate for Payer: Cash Price |
$2,518.75
|
| Rate for Payer: Cigna Commercial |
$4,181.12
|
| Rate for Payer: First Health Commercial |
$4,785.62
|
| Rate for Payer: Humana Commercial |
$4,281.88
|
| Rate for Payer: Humana KY Medicaid |
$1,732.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,750.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,130.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,717.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,767.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,030.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,382.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,475.88
|
| Rate for Payer: PHCS Commercial |
$4,836.00
|
| Rate for Payer: United Healthcare All Payer |
$4,433.00
|
|
|
MULTI-LINK 8 LL STENT 3.5*38
|
Facility
|
IP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
MULTI-LINK 8 LL STENT 3.5*38
|
Facility
|
OP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem Medicaid |
$1,384.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Humana KY Medicaid |
$1,384.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,398.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,411.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
MULTI-LINK 8 LL STENT 4*33
|
Facility
|
OP
|
$5,037.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.25 |
| Max. Negotiated Rate |
$4,836.00 |
| Rate for Payer: Aetna Commercial |
$3,878.88
|
| Rate for Payer: Anthem Medicaid |
$1,732.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.25
|
| Rate for Payer: Cash Price |
$2,518.75
|
| Rate for Payer: Cigna Commercial |
$4,181.12
|
| Rate for Payer: First Health Commercial |
$4,785.62
|
| Rate for Payer: Humana Commercial |
$4,281.88
|
| Rate for Payer: Humana KY Medicaid |
$1,732.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,750.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,130.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,717.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,767.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,030.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,382.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,475.88
|
| Rate for Payer: PHCS Commercial |
$4,836.00
|
| Rate for Payer: United Healthcare All Payer |
$4,433.00
|
|
|
MULTI-LINK 8 LL STENT 4*33
|
Facility
|
IP
|
$5,037.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.25 |
| Max. Negotiated Rate |
$4,836.00 |
| Rate for Payer: Aetna Commercial |
$3,878.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.25
|
| Rate for Payer: Cash Price |
$2,518.75
|
| Rate for Payer: Cigna Commercial |
$4,181.12
|
| Rate for Payer: First Health Commercial |
$4,785.62
|
| Rate for Payer: Humana Commercial |
$4,281.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,130.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,717.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,030.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,382.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,475.88
|
| Rate for Payer: PHCS Commercial |
$4,836.00
|
| Rate for Payer: United Healthcare All Payer |
$4,433.00
|
|
|
MULTI-LINK 8 LL STENT 4*38
|
Facility
|
IP
|
$5,037.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.25 |
| Max. Negotiated Rate |
$4,836.00 |
| Rate for Payer: Aetna Commercial |
$3,878.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.25
|
| Rate for Payer: Cash Price |
$2,518.75
|
| Rate for Payer: Cigna Commercial |
$4,181.12
|
| Rate for Payer: First Health Commercial |
$4,785.62
|
| Rate for Payer: Humana Commercial |
$4,281.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,130.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,717.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,030.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,382.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,475.88
|
| Rate for Payer: PHCS Commercial |
$4,836.00
|
| Rate for Payer: United Healthcare All Payer |
$4,433.00
|
|
|
MULTI-LINK 8 LL STENT 4*38
|
Facility
|
OP
|
$5,037.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.25 |
| Max. Negotiated Rate |
$4,836.00 |
| Rate for Payer: Aetna Commercial |
$3,878.88
|
| Rate for Payer: Anthem Medicaid |
$1,732.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.25
|
| Rate for Payer: Cash Price |
$2,518.75
|
| Rate for Payer: Cigna Commercial |
$4,181.12
|
| Rate for Payer: First Health Commercial |
$4,785.62
|
| Rate for Payer: Humana Commercial |
$4,281.88
|
| Rate for Payer: Humana KY Medicaid |
$1,732.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,750.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,130.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,717.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,767.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,030.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,382.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,475.88
|
| Rate for Payer: PHCS Commercial |
$4,836.00
|
| Rate for Payer: United Healthcare All Payer |
$4,433.00
|
|
