|
ABLTJ MAL PRST8 TISS HIFU
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 55880
|
| Hospital Charge Code |
76102853
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.02 |
| Max. Negotiated Rate |
$11,961.85 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem Medicaid |
$337.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,544.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,961.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,534.64
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$813.40
|
| Rate for Payer: First Health Commercial |
$931.00
|
| Rate for Payer: Humana Commercial |
$833.00
|
| Rate for Payer: Humana KY Medicaid |
$337.02
|
| Rate for Payer: Humana Medicare Advantage |
$8,544.18
|
| Rate for Payer: Kentucky WC Medicaid |
$340.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,253.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$862.40
|
| Rate for Payer: Ohio Health Group HMO |
$735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.20
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
|
ABLYSINOL 5ML AMPULE
|
Facility
|
IP
|
$5,422.75
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004280
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$1,626.83 |
| Max. Negotiated Rate |
$5,205.84 |
| Rate for Payer: Aetna Commercial |
$4,175.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,229.74
|
| Rate for Payer: Cash Price |
$2,711.38
|
| Rate for Payer: Cigna Commercial |
$4,500.88
|
| Rate for Payer: First Health Commercial |
$5,151.61
|
| Rate for Payer: Humana Commercial |
$4,609.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,446.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,001.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,626.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,772.02
|
| Rate for Payer: Ohio Health Group HMO |
$4,067.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,338.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,717.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,741.70
|
| Rate for Payer: PHCS Commercial |
$5,205.84
|
| Rate for Payer: United Healthcare All Payer |
$4,772.02
|
|
|
ABLYSINOL 5ML AMPULE
|
Facility
|
OP
|
$5,422.75
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004280
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$1,626.83 |
| Max. Negotiated Rate |
$5,205.84 |
| Rate for Payer: Aetna Commercial |
$4,175.52
|
| Rate for Payer: Anthem Medicaid |
$1,864.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,229.74
|
| Rate for Payer: Cash Price |
$2,711.38
|
| Rate for Payer: Cigna Commercial |
$4,500.88
|
| Rate for Payer: First Health Commercial |
$5,151.61
|
| Rate for Payer: Humana Commercial |
$4,609.34
|
| Rate for Payer: Humana KY Medicaid |
$1,864.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,883.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,446.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,001.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,626.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,902.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,772.02
|
| Rate for Payer: Ohio Health Group HMO |
$4,067.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,338.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,717.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,741.70
|
| Rate for Payer: PHCS Commercial |
$5,205.84
|
| Rate for Payer: United Healthcare All Payer |
$4,772.02
|
|
|
ABRAXANE 1MG/0.2ML(100MG/20ML)
|
Facility
|
OP
|
$8,611.33
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
25002651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$8,266.88 |
| Rate for Payer: Aetna Commercial |
$6,630.72
|
| Rate for Payer: Anthem Medicaid |
$2,961.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.36
|
| Rate for Payer: Cash Price |
$4,305.66
|
| Rate for Payer: Cash Price |
$4,305.66
|
| Rate for Payer: Cigna Commercial |
$7,147.40
|
| Rate for Payer: First Health Commercial |
$8,180.76
|
| Rate for Payer: Humana Commercial |
$7,319.63
|
| Rate for Payer: Humana KY Medicaid |
$2,961.44
|
| Rate for Payer: Humana Medicare Advantage |
$12.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,355.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,889.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,491.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,941.82
|
| Rate for Payer: PHCS Commercial |
$8,266.88
|
| Rate for Payer: United Healthcare All Payer |
$7,577.97
|
|
|
ABRAXANE 1MG/0.2ML(100MG/20ML)
|
Facility
|
IP
|
$8,611.33
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
25002651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,583.40 |
| Max. Negotiated Rate |
$8,266.88 |
| Rate for Payer: Aetna Commercial |
$6,630.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.84
|
| Rate for Payer: Cash Price |
$4,305.66
|
| Rate for Payer: Cigna Commercial |
$7,147.40
|
| Rate for Payer: First Health Commercial |
$8,180.76
|
| Rate for Payer: Humana Commercial |
$7,319.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,355.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,889.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,491.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,941.82
|
| Rate for Payer: PHCS Commercial |
$8,266.88
|
| Rate for Payer: United Healthcare All Payer |
$7,577.97
|
|
|
ABRE STENT 14*60
|
Facility
|
IP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
ABRE STENT 14*60
|
Facility
|
OP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem Medicaid |
$3,033.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Humana KY Medicaid |
$3,033.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
ABRE STENT 14*80
|
Facility
|
IP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
ABRE STENT 14*80
|
Facility
|
OP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem Medicaid |
$3,033.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Humana KY Medicaid |
$3,033.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
ABRE STENT 16*100
|
Facility
|
IP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
ABRE STENT 16*100
|
Facility
|
OP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem Medicaid |
$3,033.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Humana KY Medicaid |
$3,033.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
ABRE STENT 18*100
|
Facility
|
IP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
ABRE STENT 18*100
|
Facility
|
OP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem Medicaid |
$3,033.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Humana KY Medicaid |
$3,033.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
ABRE STENT 18*120
|
Facility
|
IP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
ABRE STENT 18*120
|
Facility
|
OP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem Medicaid |
$3,033.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Humana KY Medicaid |
$3,033.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
ABRE STENT 18*150
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
ABRE STENT 18*150
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
ABREVA 10% DENTAL CRM 2 GRAM
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
NDC 61269098135
|
| Hospital Charge Code |
25000133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna Commercial |
$0.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.22
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna Commercial |
$0.23
|
| Rate for Payer: First Health Commercial |
$0.27
|
| Rate for Payer: Humana Commercial |
$0.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.25
|
| Rate for Payer: Ohio Health Group HMO |
$0.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.19
|
| Rate for Payer: PHCS Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Payer |
$0.25
|
|
|
ABREVA 10% DENTAL CRM 2 GRAM
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
NDC 61269098135
|
| Hospital Charge Code |
25000133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna Commercial |
$0.22
|
| Rate for Payer: Anthem Medicaid |
$0.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.22
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna Commercial |
$0.23
|
| Rate for Payer: First Health Commercial |
$0.27
|
| Rate for Payer: Humana Commercial |
$0.24
|
| Rate for Payer: Humana KY Medicaid |
$0.10
|
| Rate for Payer: Kentucky WC Medicaid |
$0.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.25
|
| Rate for Payer: Ohio Health Group HMO |
$0.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.19
|
| Rate for Payer: PHCS Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Payer |
$0.25
|
|
|
ABR - SCREENING
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 92650
|
| Hospital Charge Code |
47000017
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Anthem Medicaid |
$74.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$169.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$180.11
|
| Rate for Payer: First Health Commercial |
$206.15
|
| Rate for Payer: Humana Commercial |
$184.45
|
| Rate for Payer: Humana KY Medicaid |
$74.63
|
| Rate for Payer: Kentucky WC Medicaid |
$75.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.96
|
| Rate for Payer: Ohio Health Group HMO |
$162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.73
|
| Rate for Payer: PHCS Commercial |
$208.32
|
| Rate for Payer: United Healthcare All Payer |
$190.96
|
|
|
ABR - SCREENING
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 92650
|
| Hospital Charge Code |
47000017
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$169.26
|
| Rate for Payer: Cash Price |
$108.50
|
| Rate for Payer: Cigna Commercial |
$180.11
|
| Rate for Payer: First Health Commercial |
$206.15
|
| Rate for Payer: Humana Commercial |
$184.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.96
|
| Rate for Payer: Ohio Health Group HMO |
$162.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.73
|
| Rate for Payer: PHCS Commercial |
$208.32
|
| Rate for Payer: United Healthcare All Payer |
$190.96
|
|
|
ABRYSVO 120MCG/0.5ML SDV
|
Professional
|
Both
|
$886.80
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
63600220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$310.38 |
| Max. Negotiated Rate |
$620.76 |
| Rate for Payer: Anthem Medicaid |
$320.14
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Humana Medicaid |
$320.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.54
|
| Rate for Payer: Molina Healthcare Passport |
$320.14
|
| Rate for Payer: Multiplan PHCS |
$532.08
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$620.76
|
| Rate for Payer: UHCCP Medicaid |
$310.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$323.34
|
|
|
ABRYSVO 120MCG/0.5ML SDV
|
Facility
|
IP
|
$886.80
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
63600220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$266.04 |
| Max. Negotiated Rate |
$851.33 |
| Rate for Payer: Aetna Commercial |
$682.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.70
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cigna Commercial |
$736.04
|
| Rate for Payer: First Health Commercial |
$842.46
|
| Rate for Payer: Humana Commercial |
$753.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.38
|
| Rate for Payer: Ohio Health Group HMO |
$665.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$709.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$771.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.89
|
| Rate for Payer: PHCS Commercial |
$851.33
|
| Rate for Payer: United Healthcare All Payer |
$780.38
|
|
|
ABRYSVO 120MCG/0.5ML SDV
|
Facility
|
OP
|
$886.80
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
63600220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$266.04 |
| Max. Negotiated Rate |
$851.33 |
| Rate for Payer: Aetna Commercial |
$682.84
|
| Rate for Payer: Anthem Medicaid |
$304.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.70
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cigna Commercial |
$736.04
|
| Rate for Payer: First Health Commercial |
$842.46
|
| Rate for Payer: Humana Commercial |
$753.78
|
| Rate for Payer: Humana KY Medicaid |
$304.97
|
| Rate for Payer: Kentucky WC Medicaid |
$308.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.38
|
| Rate for Payer: Ohio Health Group HMO |
$665.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$709.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$771.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.89
|
| Rate for Payer: PHCS Commercial |
$851.33
|
| Rate for Payer: United Healthcare All Payer |
$780.38
|
|
|
ABRYSVO 120MCG/0.5ML SDV
|
Facility
|
OP
|
$886.80
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
636T0220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$266.04 |
| Max. Negotiated Rate |
$851.33 |
| Rate for Payer: Aetna Commercial |
$682.84
|
| Rate for Payer: Anthem Medicaid |
$304.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.70
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cigna Commercial |
$736.04
|
| Rate for Payer: First Health Commercial |
$842.46
|
| Rate for Payer: Humana Commercial |
$753.78
|
| Rate for Payer: Humana KY Medicaid |
$304.97
|
| Rate for Payer: Kentucky WC Medicaid |
$308.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.38
|
| Rate for Payer: Ohio Health Group HMO |
$665.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$709.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$771.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.89
|
| Rate for Payer: PHCS Commercial |
$851.33
|
| Rate for Payer: United Healthcare All Payer |
$780.38
|
|
