|
ATIVAN (LORAZEPAM) 2MG/1ML
|
Facility
|
IP
|
$76.29
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
25002218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$58.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.51
|
| Rate for Payer: Cash Price |
$38.15
|
| Rate for Payer: Cigna Commercial |
$63.32
|
| Rate for Payer: First Health Commercial |
$72.48
|
| Rate for Payer: Humana Commercial |
$64.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.14
|
| Rate for Payer: Ohio Health Group HMO |
$57.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.65
|
| Rate for Payer: PHCS Commercial |
$73.24
|
| Rate for Payer: United Healthcare All Payer |
$67.14
|
|
|
ATIVAN ORAL 2MG ML LIQUID
|
Facility
|
IP
|
$60.13
|
|
|
Service Code
|
NDC 121077001
|
| Hospital Charge Code |
25000278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$57.72 |
| Rate for Payer: Aetna Commercial |
$46.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.90
|
| Rate for Payer: Cash Price |
$30.07
|
| Rate for Payer: Cigna Commercial |
$49.91
|
| Rate for Payer: First Health Commercial |
$57.12
|
| Rate for Payer: Humana Commercial |
$51.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.91
|
| Rate for Payer: Ohio Health Group HMO |
$45.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.64
|
| Rate for Payer: PHCS Commercial |
$57.72
|
| Rate for Payer: United Healthcare All Payer |
$52.91
|
|
|
ATIVAN ORAL 2MG ML LIQUID
|
Facility
|
OP
|
$60.13
|
|
|
Service Code
|
NDC 121077001
|
| Hospital Charge Code |
25000278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$57.72 |
| Rate for Payer: Aetna Commercial |
$46.30
|
| Rate for Payer: Anthem Medicaid |
$20.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.90
|
| Rate for Payer: Cash Price |
$30.07
|
| Rate for Payer: Cigna Commercial |
$49.91
|
| Rate for Payer: First Health Commercial |
$57.12
|
| Rate for Payer: Humana Commercial |
$51.11
|
| Rate for Payer: Humana KY Medicaid |
$20.68
|
| Rate for Payer: Kentucky WC Medicaid |
$20.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.91
|
| Rate for Payer: Ohio Health Group HMO |
$45.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.64
|
| Rate for Payer: PHCS Commercial |
$57.72
|
| Rate for Payer: United Healthcare All Payer |
$52.91
|
|
|
ATLAS 14*2
|
Facility
|
OP
|
$3,355.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.15 |
| Max. Negotiated Rate |
$3,220.80 |
| Rate for Payer: Anthem Medicaid |
$1,153.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,616.90
|
| Rate for Payer: Cash Price |
$1,677.50
|
| Rate for Payer: Cigna Commercial |
$2,784.65
|
| Rate for Payer: First Health Commercial |
$3,187.25
|
| Rate for Payer: Humana Commercial |
$2,851.75
|
| Rate for Payer: Humana KY Medicaid |
$1,153.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,165.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,751.10
|
| Rate for Payer: Aetna Commercial |
$2,583.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,475.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,006.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,176.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,952.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,516.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,040.05
|
| Rate for Payer: PHCS Commercial |
$3,220.80
|
| Rate for Payer: United Healthcare All Payer |
$2,952.40
|
|
|
ATLAS 14*2
|
Facility
|
IP
|
$3,355.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.15 |
| Max. Negotiated Rate |
$3,220.80 |
| Rate for Payer: Aetna Commercial |
$2,583.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,616.90
|
| Rate for Payer: Cash Price |
$1,677.50
|
| Rate for Payer: Cigna Commercial |
$2,784.65
|
| Rate for Payer: First Health Commercial |
$3,187.25
|
| Rate for Payer: Humana Commercial |
$2,851.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,751.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,475.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,006.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,952.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,516.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,040.05
|
| Rate for Payer: PHCS Commercial |
$3,220.80
|
| Rate for Payer: United Healthcare All Payer |
$2,952.40
|
|
|
ATLAS 14*4
|
Facility
|
IP
|
$3,355.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.15 |
| Max. Negotiated Rate |
$3,220.80 |
| Rate for Payer: Aetna Commercial |
$2,583.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,616.90
|
| Rate for Payer: Cash Price |
$1,677.50
|
| Rate for Payer: Cigna Commercial |
$2,784.65
|
| Rate for Payer: First Health Commercial |
$3,187.25
|
| Rate for Payer: Humana Commercial |
$2,851.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,751.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,475.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,006.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,952.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,516.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,040.05
|
| Rate for Payer: PHCS Commercial |
$3,220.80
|
| Rate for Payer: United Healthcare All Payer |
$2,952.40
|
|
|
ATLAS 14*4
|
Facility
|
OP
|
$3,355.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.15 |
| Max. Negotiated Rate |
$3,220.80 |
| Rate for Payer: Aetna Commercial |
$2,583.35
|
| Rate for Payer: Anthem Medicaid |
$1,153.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,616.90
|
| Rate for Payer: Cash Price |
$1,677.50
|
| Rate for Payer: Cigna Commercial |
$2,784.65
|
| Rate for Payer: First Health Commercial |
$3,187.25
|
| Rate for Payer: Humana Commercial |
$2,851.75
|
| Rate for Payer: Humana KY Medicaid |
$1,153.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,165.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,751.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,475.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,006.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,176.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,952.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,516.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,040.05
|
| Rate for Payer: PHCS Commercial |
$3,220.80
|
| Rate for Payer: United Healthcare All Payer |
$2,952.40
|
|
|
ATLAS 16*2
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$3,321.60 |
| Rate for Payer: Aetna Commercial |
$2,664.20
|
| Rate for Payer: Anthem Medicaid |
$1,189.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.80
|
| Rate for Payer: Cash Price |
$1,730.00
|
| Rate for Payer: Cigna Commercial |
$2,871.80
|
| Rate for Payer: First Health Commercial |
$3,287.00
|
| Rate for Payer: Humana Commercial |
$2,941.00
|
| Rate for Payer: Humana KY Medicaid |
$1,189.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,202.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,213.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.60
|
| Rate for Payer: PHCS Commercial |
$3,321.60
|
| Rate for Payer: United Healthcare All Payer |
$3,044.80
|
|
|
ATLAS 16*2
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$3,321.60 |
| Rate for Payer: Aetna Commercial |
$2,664.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.80
|
| Rate for Payer: Cash Price |
$1,730.00
|
| Rate for Payer: Cigna Commercial |
$2,871.80
|
| Rate for Payer: First Health Commercial |
$3,287.00
|
| Rate for Payer: Humana Commercial |
$2,941.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.60
|
| Rate for Payer: PHCS Commercial |
$3,321.60
|
| Rate for Payer: United Healthcare All Payer |
$3,044.80
|
|
|
ATLAS 16*4
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$3,321.60 |
| Rate for Payer: Aetna Commercial |
$2,664.20
|
| Rate for Payer: Anthem Medicaid |
$1,189.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.80
|
| Rate for Payer: Cash Price |
$1,730.00
|
| Rate for Payer: Cigna Commercial |
$2,871.80
|
| Rate for Payer: First Health Commercial |
$3,287.00
|
| Rate for Payer: Humana Commercial |
$2,941.00
|
| Rate for Payer: Humana KY Medicaid |
$1,189.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,202.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,213.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.60
|
| Rate for Payer: PHCS Commercial |
$3,321.60
|
| Rate for Payer: United Healthcare All Payer |
$3,044.80
|
|
|
ATLAS 16*4
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$3,321.60 |
| Rate for Payer: Aetna Commercial |
$2,664.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.80
|
| Rate for Payer: Cash Price |
$1,730.00
|
| Rate for Payer: Cigna Commercial |
$2,871.80
|
| Rate for Payer: First Health Commercial |
$3,287.00
|
| Rate for Payer: Humana Commercial |
$2,941.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.60
|
| Rate for Payer: PHCS Commercial |
$3,321.60
|
| Rate for Payer: United Healthcare All Payer |
$3,044.80
|
|
|
ATLAS 18*2
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$3,321.60 |
| Rate for Payer: Aetna Commercial |
$2,664.20
|
| Rate for Payer: Anthem Medicaid |
$1,189.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.80
|
| Rate for Payer: Cash Price |
$1,730.00
|
| Rate for Payer: Cigna Commercial |
$2,871.80
|
| Rate for Payer: First Health Commercial |
$3,287.00
|
| Rate for Payer: Humana Commercial |
$2,941.00
|
| Rate for Payer: Humana KY Medicaid |
$1,189.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,202.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,213.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.60
|
| Rate for Payer: PHCS Commercial |
$3,321.60
|
| Rate for Payer: United Healthcare All Payer |
$3,044.80
|
|
|
ATLAS 18*2
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$3,321.60 |
| Rate for Payer: Aetna Commercial |
$2,664.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.80
|
| Rate for Payer: Cash Price |
$1,730.00
|
| Rate for Payer: Cigna Commercial |
$2,871.80
|
| Rate for Payer: First Health Commercial |
$3,287.00
|
| Rate for Payer: Humana Commercial |
$2,941.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.60
|
| Rate for Payer: PHCS Commercial |
$3,321.60
|
| Rate for Payer: United Healthcare All Payer |
$3,044.80
|
|
|
ATLAS 18*4
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$3,321.60 |
| Rate for Payer: Aetna Commercial |
$2,664.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.80
|
| Rate for Payer: Cash Price |
$1,730.00
|
| Rate for Payer: Cigna Commercial |
$2,871.80
|
| Rate for Payer: First Health Commercial |
$3,287.00
|
| Rate for Payer: Humana Commercial |
$2,941.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.60
|
| Rate for Payer: PHCS Commercial |
$3,321.60
|
| Rate for Payer: United Healthcare All Payer |
$3,044.80
|
|
|
ATLAS 18*4
|
Facility
|
OP
|
$3,460.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.80 |
| Max. Negotiated Rate |
$3,321.60 |
| Rate for Payer: Anthem Medicaid |
$1,189.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.80
|
| Rate for Payer: Cash Price |
$1,730.00
|
| Rate for Payer: Cigna Commercial |
$2,871.80
|
| Rate for Payer: First Health Commercial |
$3,287.00
|
| Rate for Payer: Humana Commercial |
$2,941.00
|
| Rate for Payer: Humana KY Medicaid |
$1,189.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,202.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.20
|
| Rate for Payer: Aetna Commercial |
$2,664.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,213.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.60
|
| Rate for Payer: PHCS Commercial |
$3,321.60
|
| Rate for Payer: United Healthcare All Payer |
$3,044.80
|
|
|
ATLAS 20*2
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ATLAS 20*2
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ATLAS 20*4
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ATLAS 20*4
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ATOPOBIUM VAGINAE PCR
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$214.83
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$231.57
|
| Rate for Payer: First Health Commercial |
$265.05
|
| Rate for Payer: Humana Commercial |
$237.15
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$228.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$245.52
|
| Rate for Payer: Ohio Health Group HMO |
$209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.49
|
| Rate for Payer: PHCS Commercial |
$267.84
|
| Rate for Payer: United Healthcare All Payer |
$245.52
|
|
|
ATOPOBIUM VAGINAE PCR
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.27 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$214.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.04
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$231.57
|
| Rate for Payer: First Health Commercial |
$265.05
|
| Rate for Payer: Humana Commercial |
$237.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$228.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$245.52
|
| Rate for Payer: Ohio Health Group HMO |
$209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.49
|
| Rate for Payer: PHCS Commercial |
$267.84
|
| Rate for Payer: United Healthcare All Payer |
$245.52
|
|
|
ATOPOBIUM VAGINAE PCR
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$279.00
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Multiplan PHCS |
$167.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$195.30
|
| Rate for Payer: UHCCP Medicaid |
$97.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
ATRACURIUM 50MG/5ML VIAL (5ML)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
NDC 71288070106
|
| Hospital Charge Code |
25002854
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$39.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$39.55
|
| Rate for Payer: Kentucky WC Medicaid |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
ATRACURIUM 50MG/5ML VIAL (5ML)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
NDC 71288070106
|
| Hospital Charge Code |
25002854
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
ATRICULEZE M HEAD 36MM +12
|
Facility
|
IP
|
$6,588.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.53 |
| Max. Negotiated Rate |
$6,325.15 |
| Rate for Payer: Aetna Commercial |
$5,073.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,139.19
|
| Rate for Payer: Cash Price |
$3,294.35
|
| Rate for Payer: Cigna Commercial |
$5,468.62
|
| Rate for Payer: First Health Commercial |
$6,259.26
|
| Rate for Payer: Humana Commercial |
$5,600.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,402.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,862.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,976.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,798.06
|
| Rate for Payer: Ohio Health Group HMO |
$4,941.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,317.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,042.50
|
| Rate for Payer: PHCS Commercial |
$6,325.15
|
| Rate for Payer: United Healthcare All Payer |
$5,798.06
|
|
