|
O-F II ACET SHELL 54MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 54MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 56MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 56MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 58MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 58MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 60MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 60MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 62MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 62MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 64MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 64MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 66MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 66MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 68MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 68MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 70MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 70MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
OFLOXACIN 0.5% EYE DROPS 5ML
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
25003311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Aetna Commercial |
$0.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.70
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna Commercial |
$0.75
|
| Rate for Payer: First Health Commercial |
$0.86
|
| Rate for Payer: Humana Commercial |
$0.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.79
|
| Rate for Payer: Ohio Health Group HMO |
$0.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.28
|
| Rate for Payer: PHCS Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Payer |
$0.79
|
|
|
OFLOXACIN 0.5% EYE DROPS 5ML
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
25003311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Aetna Commercial |
$0.69
|
| Rate for Payer: Anthem Medicaid |
$0.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.70
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna Commercial |
$0.75
|
| Rate for Payer: First Health Commercial |
$0.86
|
| Rate for Payer: Humana Commercial |
$0.77
|
| Rate for Payer: Humana KY Medicaid |
$0.31
|
| Rate for Payer: Kentucky WC Medicaid |
$0.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.79
|
| Rate for Payer: Ohio Health Group HMO |
$0.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.28
|
| Rate for Payer: PHCS Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Payer |
$0.79
|
|
|
OGIVRI 10mg (150mg SDV)
|
Facility
|
IP
|
$5,125.78
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
25004110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$666.35 |
| Max. Negotiated Rate |
$4,920.75 |
| Rate for Payer: Aetna Commercial |
$3,946.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.11
|
| Rate for Payer: Cash Price |
$2,562.89
|
| Rate for Payer: Cigna Commercial |
$4,254.40
|
| Rate for Payer: First Health Commercial |
$4,869.49
|
| Rate for Payer: Humana Commercial |
$4,356.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,782.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,510.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,588.99
|
| Rate for Payer: PHCS Commercial |
$4,920.75
|
| Rate for Payer: United Healthcare All Payer |
$4,510.69
|
|
|
OGIVRI 10mg (150mg SDV)
|
Facility
|
OP
|
$5,125.78
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
25004110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.43 |
| Max. Negotiated Rate |
$4,920.75 |
| Rate for Payer: Aetna Commercial |
$3,946.85
|
| Rate for Payer: Anthem Medicaid |
$1,762.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$44.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$62.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.98
|
| Rate for Payer: Cash Price |
$2,562.89
|
| Rate for Payer: Cash Price |
$2,562.89
|
| Rate for Payer: Cigna Commercial |
$4,254.40
|
| Rate for Payer: First Health Commercial |
$4,869.49
|
| Rate for Payer: Humana Commercial |
$4,356.91
|
| Rate for Payer: Humana KY Medicaid |
$1,762.76
|
| Rate for Payer: Humana Medicare Advantage |
$44.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,782.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,510.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,025.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,588.99
|
| Rate for Payer: PHCS Commercial |
$4,920.75
|
| Rate for Payer: United Healthcare All Payer |
$4,510.69
|
|
|
OGIVRI 10mg (from 420mg MDV)
|
Facility
|
IP
|
$340.63
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
25004111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.28 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Aetna Commercial |
$262.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.69
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cigna Commercial |
$282.72
|
| Rate for Payer: First Health Commercial |
$323.60
|
| Rate for Payer: Humana Commercial |
$289.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.75
|
| Rate for Payer: Ohio Health Group HMO |
$255.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.60
|
| Rate for Payer: PHCS Commercial |
$327.00
|
| Rate for Payer: United Healthcare All Payer |
$299.75
|
|
|
OGIVRI 10mg (from 420mg MDV)
|
Facility
|
OP
|
$340.63
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
25004111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.28 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Aetna Commercial |
$262.29
|
| Rate for Payer: Anthem Medicaid |
$117.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$44.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$62.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.98
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cigna Commercial |
$282.72
|
| Rate for Payer: First Health Commercial |
$323.60
|
| Rate for Payer: Humana Commercial |
$289.54
|
| Rate for Payer: Humana KY Medicaid |
$117.14
|
| Rate for Payer: Humana Medicare Advantage |
$44.43
|
| Rate for Payer: Kentucky WC Medicaid |
$118.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.75
|
| Rate for Payer: Ohio Health Group HMO |
$255.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.60
|
| Rate for Payer: PHCS Commercial |
$327.00
|
| Rate for Payer: United Healthcare All Payer |
$299.75
|
|
|
OLANZAPINE 0.5mg (10mg SDV)
|
Facility
|
IP
|
$184.07
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
25003646
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$176.71 |
| Rate for Payer: Aetna Commercial |
$141.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.57
|
| Rate for Payer: Cash Price |
$92.03
|
| Rate for Payer: Cigna Commercial |
$152.78
|
| Rate for Payer: First Health Commercial |
$174.87
|
| Rate for Payer: Humana Commercial |
$156.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.98
|
| Rate for Payer: Ohio Health Group HMO |
$138.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.06
|
| Rate for Payer: PHCS Commercial |
$176.71
|
| Rate for Payer: United Healthcare All Payer |
$161.98
|
|
