|
ARMIDEX (ANASTROZOLE) 1MG TAB
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 68001015504
|
| Hospital Charge Code |
25000250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Anthem Medicaid |
$0.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.13
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cigna Commercial |
$2.27
|
| Rate for Payer: First Health Commercial |
$2.59
|
| Rate for Payer: Humana Commercial |
$2.32
|
| Rate for Payer: Humana KY Medicaid |
$0.94
|
| Rate for Payer: Kentucky WC Medicaid |
$0.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.24
|
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.40
|
| Rate for Payer: Ohio Health Group HMO |
$2.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.85
|
| Rate for Payer: PHCS Commercial |
$2.62
|
| Rate for Payer: United Healthcare All Payer |
$2.40
|
|
|
ARMIDEX (ANASTROZOLE) 1MG TAB
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 68001015504
|
| Hospital Charge Code |
25000250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.13
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cigna Commercial |
$2.27
|
| Rate for Payer: First Health Commercial |
$2.59
|
| Rate for Payer: Humana Commercial |
$2.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.40
|
| Rate for Payer: Ohio Health Group HMO |
$2.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.85
|
| Rate for Payer: PHCS Commercial |
$2.62
|
| Rate for Payer: United Healthcare All Payer |
$2.40
|
|
|
AR MOD CATH 5F
|
Facility
|
IP
|
$785.62
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.13 |
| Max. Negotiated Rate |
$754.20 |
| Rate for Payer: Aetna Commercial |
$604.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.78
|
| Rate for Payer: Cash Price |
$392.81
|
| Rate for Payer: Cigna Commercial |
$652.06
|
| Rate for Payer: First Health Commercial |
$746.34
|
| Rate for Payer: Humana Commercial |
$667.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$644.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$691.35
|
| Rate for Payer: Ohio Health Group HMO |
$589.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.54
|
| Rate for Payer: PHCS Commercial |
$754.20
|
| Rate for Payer: United Healthcare All Payer |
$691.35
|
|
|
AR MOD CATH 5F
|
Facility
|
OP
|
$785.62
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.13 |
| Max. Negotiated Rate |
$754.20 |
| Rate for Payer: Aetna Commercial |
$604.93
|
| Rate for Payer: Anthem Medicaid |
$270.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.78
|
| Rate for Payer: Cash Price |
$392.81
|
| Rate for Payer: Cigna Commercial |
$652.06
|
| Rate for Payer: First Health Commercial |
$746.34
|
| Rate for Payer: Humana Commercial |
$667.78
|
| Rate for Payer: Humana KY Medicaid |
$270.17
|
| Rate for Payer: Kentucky WC Medicaid |
$272.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$644.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$691.35
|
| Rate for Payer: Ohio Health Group HMO |
$589.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.54
|
| Rate for Payer: PHCS Commercial |
$754.20
|
| Rate for Payer: United Healthcare All Payer |
$691.35
|
|
|
ARMOUR THYROID 15MG TABLET
|
Facility
|
IP
|
$4.79
|
|
|
Service Code
|
NDC 42192032701
|
| Hospital Charge Code |
25000251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.55
|
| Rate for Payer: Humana Commercial |
$4.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.60
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
ARMOUR THYROID 15MG TABLET
|
Facility
|
OP
|
$4.79
|
|
|
Service Code
|
NDC 42192032701
|
| Hospital Charge Code |
25000251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.55
|
| Rate for Payer: Humana Commercial |
$4.07
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.60
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
ARMOUR THYROID 30 MG TABLET
|
Facility
|
IP
|
$4.89
|
|
|
Service Code
|
NDC 42192032901
|
| Hospital Charge Code |
25000252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.06
|
| Rate for Payer: First Health Commercial |
$4.65
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.30
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
|
|
ARMOUR THYROID 30 MG TABLET
|
Facility
|
OP
|
$4.89
|
|
|
Service Code
|
NDC 42192032901
|
| Hospital Charge Code |
25000252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| 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 |
$4.06
|
| Rate for Payer: First Health Commercial |
$4.65
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Humana KY Medicaid |
$1.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.30
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
|
|
Arms - Full Laser Hair Removal
|
Professional
|
Both
|
$425.00
|
|
| Hospital Charge Code |
22200218
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
|
|
Arms-Full Lsr HairRem-PP#1 50%
|
Professional
|
Both
|
$543.00
|
|
| Hospital Charge Code |
22200219
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$190.05 |
| Max. Negotiated Rate |
$543.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$543.00
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Multiplan PHCS |
$325.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$380.10
|
| Rate for Payer: UHCCP Medicaid |
$190.05
|
|
|
Arms-FulLsr HairRem-PP#2/3 25%
|
Professional
|
Both
|
$270.00
|
|
| Hospital Charge Code |
22200475
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$270.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.00
|
| Rate for Payer: UHCCP Medicaid |
$94.50
|
|
|
Arms Laser Hair Removal
|
Professional
|
Both
|
$225.00
|
|
| Hospital Charge Code |
22200181
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
|
|
Arms LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$287.00
|
|
| Hospital Charge Code |
22200345
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$287.00
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Multiplan PHCS |
$172.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$200.90
|
| Rate for Payer: UHCCP Medicaid |
$100.45
|
|
|
Arms LsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$143.00
|
|
| Hospital Charge Code |
22200461
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$143.00
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Multiplan PHCS |
$85.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.10
|
| Rate for Payer: UHCCP Medicaid |
$50.05
|
|
|
AROMASIN(EXEMESTANE) 25MG TAB
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
NDC 59762285801
|
| Hospital Charge Code |
25000253
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$7.01
|
| Rate for Payer: Anthem Medicaid |
$3.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.10
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cigna Commercial |
$7.55
|
| Rate for Payer: First Health Commercial |
$8.64
|
| Rate for Payer: Humana Commercial |
$7.74
|
| Rate for Payer: Humana KY Medicaid |
$3.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.01
|
| Rate for Payer: Ohio Health Group HMO |
$6.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.82
|
| Rate for Payer: PHCS Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Payer |
$8.01
|
|
|
AROMASIN(EXEMESTANE) 25MG TAB
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
NDC 59762285801
|
| Hospital Charge Code |
25000253
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$7.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.10
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cigna Commercial |
$7.55
|
| Rate for Payer: First Health Commercial |
$8.64
|
| Rate for Payer: Humana Commercial |
$7.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.01
|
| Rate for Payer: Ohio Health Group HMO |
$6.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.82
|
| Rate for Payer: PHCS Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Payer |
$8.01
|
|
|
AROMATIC AMMONIA VAPOROLE 1EA
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 39822990002
|
| Hospital Charge Code |
25000254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: First Health Commercial |
$4.41
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.08
|
| Rate for Payer: Ohio Health Group HMO |
$3.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Payer |
$4.08
|
|
|
AROMATIC AMMONIA VAPOROLE 1EA
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 39822990002
|
| Hospital Charge Code |
25000254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: First Health Commercial |
$4.41
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.08
|
| Rate for Payer: Ohio Health Group HMO |
$3.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Payer |
$4.08
|
|
|
ARROW 4.5FR SNGL PICC W/CHLORA
|
Facility
|
IP
|
$2,150.10
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$2,064.10 |
| Rate for Payer: Aetna Commercial |
$1,655.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,677.08
|
| Rate for Payer: Cash Price |
$1,075.05
|
| Rate for Payer: Cigna Commercial |
$1,784.58
|
| Rate for Payer: First Health Commercial |
$2,042.60
|
| Rate for Payer: Humana Commercial |
$1,827.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,763.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,586.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$645.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,892.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,612.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$666.53
|
| Rate for Payer: PHCS Commercial |
$2,064.10
|
| Rate for Payer: United Healthcare All Payer |
$1,892.09
|
|
|
ARROW 4.5FR SNGL PICC W/CHLORA
|
Facility
|
OP
|
$2,150.10
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$2,064.10 |
| Rate for Payer: Aetna Commercial |
$1,655.58
|
| Rate for Payer: Anthem Medicaid |
$739.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,677.08
|
| Rate for Payer: Cash Price |
$1,075.05
|
| Rate for Payer: Cigna Commercial |
$1,784.58
|
| Rate for Payer: First Health Commercial |
$2,042.60
|
| Rate for Payer: Humana Commercial |
$1,827.58
|
| Rate for Payer: Humana KY Medicaid |
$739.42
|
| Rate for Payer: Kentucky WC Medicaid |
$746.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,763.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,586.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$645.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$754.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,892.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,612.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$666.53
|
| Rate for Payer: PHCS Commercial |
$2,064.10
|
| Rate for Payer: United Healthcare All Payer |
$1,892.09
|
|
|
ARROW 5.5FR DUAL PICC W/CHLORA
|
Facility
|
OP
|
$5,567.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.71 |
| Max. Negotiated Rate |
$5,344.32 |
| Rate for Payer: Aetna Commercial |
$4,286.59
|
| Rate for Payer: Anthem Medicaid |
$1,914.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,342.26
|
| Rate for Payer: Cash Price |
$2,783.50
|
| Rate for Payer: Cigna Commercial |
$4,620.61
|
| Rate for Payer: First Health Commercial |
$5,288.65
|
| Rate for Payer: Humana Commercial |
$4,731.95
|
| Rate for Payer: Humana KY Medicaid |
$1,914.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,933.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,564.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,108.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,670.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,952.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,898.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,175.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,113.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.77
|
| Rate for Payer: PHCS Commercial |
$5,344.32
|
| Rate for Payer: United Healthcare All Payer |
$4,898.96
|
|
|
ARROW 5.5FR DUAL PICC W/CHLORA
|
Facility
|
IP
|
$5,567.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$723.71 |
| Max. Negotiated Rate |
$5,344.32 |
| Rate for Payer: Aetna Commercial |
$4,286.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,342.26
|
| Rate for Payer: Cash Price |
$2,783.50
|
| Rate for Payer: Cigna Commercial |
$4,620.61
|
| Rate for Payer: First Health Commercial |
$5,288.65
|
| Rate for Payer: Humana Commercial |
$4,731.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,564.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,108.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,670.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,898.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,175.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,113.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.77
|
| Rate for Payer: PHCS Commercial |
$5,344.32
|
| Rate for Payer: United Healthcare All Payer |
$4,898.96
|
|
|
ART 3.5 GUIDE 8FR
|
Facility
|
IP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 3.5 GUIDE 8FR
|
Facility
|
OP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem Medicaid |
$370.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Humana KY Medicaid |
$370.69
|
| Rate for Payer: Kentucky WC Medicaid |
$374.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 3.5 GUIDE CATH 6FR
|
Facility
|
IP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
