|
AS INVRS HUM CUP +20 DEG RETRO
|
Facility
|
OP
|
$8,435.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.63 |
| Max. Negotiated Rate |
$8,098.18 |
| Rate for Payer: Aetna Commercial |
$6,495.41
|
| Rate for Payer: Anthem Medicaid |
$2,901.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
| Rate for Payer: Cash Price |
$4,217.80
|
| Rate for Payer: Cigna Commercial |
$7,001.55
|
| Rate for Payer: First Health Commercial |
$8,013.82
|
| Rate for Payer: Humana Commercial |
$7,170.26
|
| Rate for Payer: Humana KY Medicaid |
$2,901.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,930.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,959.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
| Rate for Payer: PHCS Commercial |
$8,098.18
|
| Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
|
AS INVRS HUM CUP -20 DEG RETRO
|
Facility
|
OP
|
$8,435.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.63 |
| Max. Negotiated Rate |
$8,098.18 |
| Rate for Payer: Aetna Commercial |
$6,495.41
|
| Rate for Payer: Anthem Medicaid |
$2,901.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
| Rate for Payer: Cash Price |
$4,217.80
|
| Rate for Payer: Cigna Commercial |
$7,001.55
|
| Rate for Payer: First Health Commercial |
$8,013.82
|
| Rate for Payer: Humana Commercial |
$7,170.26
|
| Rate for Payer: Humana KY Medicaid |
$2,901.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,930.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,959.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
| Rate for Payer: PHCS Commercial |
$8,098.18
|
| Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
|
AS INVRS HUM CUP -20 DEG RETRO
|
Facility
|
IP
|
$8,435.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.63 |
| Max. Negotiated Rate |
$8,098.18 |
| Rate for Payer: Aetna Commercial |
$6,495.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
| Rate for Payer: Cash Price |
$4,217.80
|
| Rate for Payer: Cigna Commercial |
$7,001.55
|
| Rate for Payer: First Health Commercial |
$8,013.82
|
| Rate for Payer: Humana Commercial |
$7,170.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
| Rate for Payer: PHCS Commercial |
$8,098.18
|
| Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
|
AS INVRS HUM CUP +9 0DEG RETR
|
Facility
|
OP
|
$8,435.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.63 |
| Max. Negotiated Rate |
$8,098.18 |
| Rate for Payer: Aetna Commercial |
$6,495.41
|
| Rate for Payer: Anthem Medicaid |
$2,901.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
| Rate for Payer: Cash Price |
$4,217.80
|
| Rate for Payer: Cigna Commercial |
$7,001.55
|
| Rate for Payer: First Health Commercial |
$8,013.82
|
| Rate for Payer: Humana Commercial |
$7,170.26
|
| Rate for Payer: Humana KY Medicaid |
$2,901.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,930.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,959.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
| Rate for Payer: PHCS Commercial |
$8,098.18
|
| Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
|
AS INVRS HUM CUP +9 0DEG RETR
|
Facility
|
IP
|
$8,435.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.63 |
| Max. Negotiated Rate |
$8,098.18 |
| Rate for Payer: Aetna Commercial |
$6,495.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
| Rate for Payer: Cash Price |
$4,217.80
|
| Rate for Payer: Cigna Commercial |
$7,001.55
|
| Rate for Payer: First Health Commercial |
$8,013.82
|
| Rate for Payer: Humana Commercial |
$7,170.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
| Rate for Payer: PHCS Commercial |
$8,098.18
|
| Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
|
AS INVRS HUM CUP +9MM DEG RETR
|
Facility
|
IP
|
$8,435.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.63 |
| Max. Negotiated Rate |
$8,098.18 |
| Rate for Payer: Aetna Commercial |
$6,495.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
| Rate for Payer: Cash Price |
$4,217.80
|
| Rate for Payer: Cigna Commercial |
$7,001.55
|
| Rate for Payer: First Health Commercial |
$8,013.82
|
| Rate for Payer: Humana Commercial |
$7,170.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
| Rate for Payer: PHCS Commercial |
$8,098.18
|
| Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
|
AS INVRS HUM CUP +9MM DEG RETR
|
Facility
|
OP
|
$8,435.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.63 |
| Max. Negotiated Rate |
$8,098.18 |
| Rate for Payer: Aetna Commercial |
$6,495.41
|
| Rate for Payer: Anthem Medicaid |
$2,901.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
| Rate for Payer: Cash Price |
$4,217.80
|
| Rate for Payer: Cigna Commercial |
$7,001.55
|
| Rate for Payer: First Health Commercial |
$8,013.82
|
| Rate for Payer: Humana Commercial |
$7,170.26
|
| Rate for Payer: Humana KY Medicaid |
$2,901.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,930.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,959.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
| Rate for Payer: PHCS Commercial |
$8,098.18
|
| Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
|
AS INVRS HUM PE-INLAY0MM36MMHD
|
Facility
|
IP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INVRS HUM PE-INLAY0MM36MMHD
|
Facility
|
OP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem Medicaid |
$2,421.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Humana KY Medicaid |
$2,421.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,445.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,469.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INVRS HUM PE-INLAY 3MM 36MM
|
Facility
|
OP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem Medicaid |
$2,421.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Humana KY Medicaid |
$2,421.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,445.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,469.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INVRS HUM PE-INLAY 3MM 36MM
|
Facility
|
IP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INVRS HUM PE-INLAY 6MM 36MM
|
Facility
|
IP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INVRS HUM PE-INLAY 6MM 36MM
|
Facility
|
OP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem Medicaid |
$2,421.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Humana KY Medicaid |
$2,421.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,445.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,469.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
ASMANEX 220MCG 60 MDI
|
Facility
|
OP
|
$535.90
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.67 |
| Max. Negotiated Rate |
$514.46 |
| Rate for Payer: Aetna Commercial |
$412.64
|
| Rate for Payer: Anthem Medicaid |
$184.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.00
|
| Rate for Payer: Cash Price |
$267.95
|
| Rate for Payer: Cigna Commercial |
$444.80
|
| Rate for Payer: First Health Commercial |
$509.10
|
| Rate for Payer: Humana Commercial |
$455.52
|
| Rate for Payer: Humana KY Medicaid |
$184.30
|
| Rate for Payer: Kentucky WC Medicaid |
$186.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$439.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.59
|
| Rate for Payer: Ohio Health Group HMO |
$401.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.13
|
| Rate for Payer: PHCS Commercial |
$514.46
|
| Rate for Payer: United Healthcare All Payer |
$471.59
|
|
|
ASMANEX 220MCG 60 MDI
|
Facility
|
IP
|
$535.90
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.67 |
| Max. Negotiated Rate |
$514.46 |
| Rate for Payer: Aetna Commercial |
$412.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.00
|
| Rate for Payer: Cash Price |
$267.95
|
| Rate for Payer: Cigna Commercial |
$444.80
|
| Rate for Payer: First Health Commercial |
$509.10
|
| Rate for Payer: Humana Commercial |
$455.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$439.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.59
|
| Rate for Payer: Ohio Health Group HMO |
$401.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.13
|
| Rate for Payer: PHCS Commercial |
$514.46
|
| Rate for Payer: United Healthcare All Payer |
$471.59
|
|
|
ASMANEX 220MCG INHALER
|
Facility
|
IP
|
$189.80
|
|
|
Service Code
|
NDC 78206011403
|
| Hospital Charge Code |
25002852
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.67 |
| Max. Negotiated Rate |
$182.21 |
| Rate for Payer: Aetna Commercial |
$146.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.04
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cigna Commercial |
$157.53
|
| Rate for Payer: First Health Commercial |
$180.31
|
| Rate for Payer: Humana Commercial |
$161.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.02
|
| Rate for Payer: Ohio Health Group HMO |
$142.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.84
|
| Rate for Payer: PHCS Commercial |
$182.21
|
| Rate for Payer: United Healthcare All Payer |
$167.02
|
|
|
ASMANEX 220MCG INHALER
|
Facility
|
OP
|
$189.80
|
|
|
Service Code
|
NDC 78206011403
|
| Hospital Charge Code |
25002852
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.67 |
| Max. Negotiated Rate |
$182.21 |
| Rate for Payer: Aetna Commercial |
$146.15
|
| Rate for Payer: Anthem Medicaid |
$65.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.04
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cigna Commercial |
$157.53
|
| Rate for Payer: First Health Commercial |
$180.31
|
| Rate for Payer: Humana Commercial |
$161.33
|
| Rate for Payer: Humana KY Medicaid |
$65.27
|
| Rate for Payer: Kentucky WC Medicaid |
$65.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.02
|
| Rate for Payer: Ohio Health Group HMO |
$142.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.84
|
| Rate for Payer: PHCS Commercial |
$182.21
|
| Rate for Payer: United Healthcare All Payer |
$167.02
|
|
|
ASNIS MCRO 2.0 KWIRE 0.8*100MM
|
Facility
|
OP
|
$556.36
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.33 |
| Max. Negotiated Rate |
$534.11 |
| Rate for Payer: Aetna Commercial |
$428.40
|
| Rate for Payer: Anthem Medicaid |
$191.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$433.96
|
| Rate for Payer: Cash Price |
$278.18
|
| Rate for Payer: Cigna Commercial |
$461.78
|
| Rate for Payer: First Health Commercial |
$528.54
|
| Rate for Payer: Humana Commercial |
$472.91
|
| Rate for Payer: Humana KY Medicaid |
$191.33
|
| Rate for Payer: Kentucky WC Medicaid |
$193.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$456.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$410.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$489.60
|
| Rate for Payer: Ohio Health Group HMO |
$417.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.47
|
| Rate for Payer: PHCS Commercial |
$534.11
|
| Rate for Payer: United Healthcare All Payer |
$489.60
|
|
|
ASNIS MCRO 2.0 KWIRE 0.8*100MM
|
Facility
|
IP
|
$556.36
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.33 |
| Max. Negotiated Rate |
$534.11 |
| Rate for Payer: Aetna Commercial |
$428.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$433.96
|
| Rate for Payer: Cash Price |
$278.18
|
| Rate for Payer: Cigna Commercial |
$461.78
|
| Rate for Payer: First Health Commercial |
$528.54
|
| Rate for Payer: Humana Commercial |
$472.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$456.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$410.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$489.60
|
| Rate for Payer: Ohio Health Group HMO |
$417.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.47
|
| Rate for Payer: PHCS Commercial |
$534.11
|
| Rate for Payer: United Healthcare All Payer |
$489.60
|
|
|
AS NUT FOR FEM STEM NEUTRAL
|
Facility
|
IP
|
$5,381.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.60 |
| Max. Negotiated Rate |
$5,166.24 |
| Rate for Payer: Aetna Commercial |
$4,143.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,197.57
|
| Rate for Payer: Cash Price |
$2,690.75
|
| Rate for Payer: Cigna Commercial |
$4,466.64
|
| Rate for Payer: First Health Commercial |
$5,112.42
|
| Rate for Payer: Humana Commercial |
$4,574.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,412.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,971.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,614.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,735.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,036.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,076.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$699.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,668.26
|
| Rate for Payer: PHCS Commercial |
$5,166.24
|
| Rate for Payer: United Healthcare All Payer |
$4,735.72
|
|
|
AS NUT FOR FEM STEM NEUTRAL
|
Facility
|
OP
|
$5,381.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.60 |
| Max. Negotiated Rate |
$5,166.24 |
| Rate for Payer: Aetna Commercial |
$4,143.76
|
| Rate for Payer: Anthem Medicaid |
$1,850.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,197.57
|
| Rate for Payer: Cash Price |
$2,690.75
|
| Rate for Payer: Cigna Commercial |
$4,466.64
|
| Rate for Payer: First Health Commercial |
$5,112.42
|
| Rate for Payer: Humana Commercial |
$4,574.28
|
| Rate for Payer: Humana KY Medicaid |
$1,850.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,869.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,412.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,971.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,614.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,887.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,735.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,036.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,076.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$699.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,668.26
|
| Rate for Payer: PHCS Commercial |
$5,166.24
|
| Rate for Payer: United Healthcare All Payer |
$4,735.72
|
|
|
ASP BIOP NEEDL SHTH NA-1C/2C
|
Facility
|
OP
|
$1,702.56
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.33 |
| Max. Negotiated Rate |
$1,634.46 |
| Rate for Payer: Aetna Commercial |
$1,310.97
|
| Rate for Payer: Anthem Medicaid |
$585.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.00
|
| Rate for Payer: Cash Price |
$851.28
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: First Health Commercial |
$1,617.43
|
| Rate for Payer: Humana Commercial |
$1,447.18
|
| Rate for Payer: Humana KY Medicaid |
$585.51
|
| Rate for Payer: Kentucky WC Medicaid |
$591.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$597.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.25
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.79
|
| Rate for Payer: PHCS Commercial |
$1,634.46
|
| Rate for Payer: United Healthcare All Payer |
$1,498.25
|
|
|
ASP BIOP NEEDL SHTH NA-1C/2C
|
Facility
|
IP
|
$1,702.56
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.33 |
| Max. Negotiated Rate |
$1,634.46 |
| Rate for Payer: Aetna Commercial |
$1,310.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.00
|
| Rate for Payer: Cash Price |
$851.28
|
| Rate for Payer: Cigna Commercial |
$1,413.12
|
| Rate for Payer: First Health Commercial |
$1,617.43
|
| Rate for Payer: Humana Commercial |
$1,447.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.25
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.79
|
| Rate for Payer: PHCS Commercial |
$1,634.46
|
| Rate for Payer: United Healthcare All Payer |
$1,498.25
|
|
|
ASPERGILLUS FUMIGATUS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| 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 |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
ASPERGILLUS FUMIGATUS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
