|
AVENIR FEM STEM STD SZ 7
|
Facility
|
IP
|
$20,403.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.49 |
| Max. Negotiated Rate |
$19,587.60 |
| Rate for Payer: Aetna Commercial |
$15,710.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,914.92
|
| Rate for Payer: Cash Price |
$10,201.88
|
| Rate for Payer: Cigna Commercial |
$16,935.11
|
| Rate for Payer: First Health Commercial |
$19,383.56
|
| Rate for Payer: Humana Commercial |
$17,343.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,731.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,057.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,121.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,955.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,302.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,652.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,325.16
|
| Rate for Payer: PHCS Commercial |
$19,587.60
|
| Rate for Payer: United Healthcare All Payer |
$17,955.30
|
|
|
AVENIR FEM STEM STD SZ 7
|
Facility
|
OP
|
$20,403.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.49 |
| Max. Negotiated Rate |
$19,587.60 |
| Rate for Payer: Aetna Commercial |
$15,710.89
|
| Rate for Payer: Anthem Medicaid |
$7,016.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,914.92
|
| Rate for Payer: Cash Price |
$10,201.88
|
| Rate for Payer: Cigna Commercial |
$16,935.11
|
| Rate for Payer: First Health Commercial |
$19,383.56
|
| Rate for Payer: Humana Commercial |
$17,343.19
|
| Rate for Payer: Humana KY Medicaid |
$7,016.85
|
| Rate for Payer: Kentucky WC Medicaid |
$7,088.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,731.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,057.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,121.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,157.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,955.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,302.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,652.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,325.16
|
| Rate for Payer: PHCS Commercial |
$19,587.60
|
| Rate for Payer: United Healthcare All Payer |
$17,955.30
|
|
|
AV FIST CEPHAL BRACH FISTUA
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 36818
|
| Hospital Charge Code |
76101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Anthem Medicaid |
$371.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$842.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$896.40
|
| Rate for Payer: First Health Commercial |
$1,026.00
|
| Rate for Payer: Humana Commercial |
$918.00
|
| Rate for Payer: Humana KY Medicaid |
$371.41
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$375.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$885.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$797.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$950.40
|
| Rate for Payer: Ohio Health Group HMO |
$810.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.80
|
| Rate for Payer: PHCS Commercial |
$1,036.80
|
| Rate for Payer: United Healthcare All Payer |
$950.40
|
|
|
AV FIST CEPHAL BRACH FISTUA
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 36818
|
| Hospital Charge Code |
76101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$1,036.80 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$842.40
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$896.40
|
| Rate for Payer: First Health Commercial |
$1,026.00
|
| Rate for Payer: Humana Commercial |
$918.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$885.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$797.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$950.40
|
| Rate for Payer: Ohio Health Group HMO |
$810.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.80
|
| Rate for Payer: PHCS Commercial |
$1,036.80
|
| Rate for Payer: United Healthcare All Payer |
$950.40
|
|
|
AV FIST CEPHAL BRACH FISTUA
|
Professional
|
Both
|
$1,080.00
|
|
|
Service Code
|
HCPCS 36818
|
| Hospital Charge Code |
76101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$1,086.76 |
| Rate for Payer: Aetna Commercial |
$1,086.76
|
| Rate for Payer: Anthem Medicaid |
$544.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,080.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$1,050.66
|
| Rate for Payer: Healthspan PPO |
$868.97
|
| Rate for Payer: Humana Medicaid |
$544.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$897.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$555.25
|
| Rate for Payer: Molina Healthcare Passport |
$544.36
|
| Rate for Payer: Multiplan PHCS |
$648.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$756.00
|
| Rate for Payer: UHCCP Medicaid |
$378.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$549.80
|
|
|
AV FIST CEPHAL BRACH FISTUA(P
|
Professional
|
Both
|
$1,080.00
|
|
|
Service Code
|
HCPCS 36818
|
| Hospital Charge Code |
761P1504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$1,086.76 |
| Rate for Payer: Aetna Commercial |
$1,086.76
|
| Rate for Payer: Anthem Medicaid |
$544.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,080.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$1,050.66
|
| Rate for Payer: Healthspan PPO |
$868.97
|
| Rate for Payer: Humana Medicaid |
$544.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$897.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$555.25
|
| Rate for Payer: Molina Healthcare Passport |
$544.36
|
| Rate for Payer: Multiplan PHCS |
$648.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$756.00
|
| Rate for Payer: UHCCP Medicaid |
$378.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$549.80
|
|
|
AVISTA MRI PERC LEAD 56CM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
AVISTA MRI PERC LEAD 56CM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
AVISTA MRI PERC LEAD 74CM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
AVISTA MRI PERC LEAD 74CM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
AVITENE(MICRO COLL HEMO)35 1EA
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
NDC 53276101009
|
| Hospital Charge Code |
27000237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem Medicaid |
$123.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Humana KY Medicaid |
$123.80
|
| Rate for Payer: Kentucky WC Medicaid |
$125.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.60
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
AVITENE(MICRO COLL HEMO)35 1EA
|
Facility
|
OP
|
$337.09
|
|
| Hospital Charge Code |
27000237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.82 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$259.56
|
| Rate for Payer: Anthem Medicaid |
$115.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.93
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cigna Commercial |
$279.78
|
| Rate for Payer: First Health Commercial |
$320.24
|
| Rate for Payer: Humana Commercial |
$286.53
|
| Rate for Payer: Humana KY Medicaid |
$115.93
|
| Rate for Payer: Kentucky WC Medicaid |
$117.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.64
|
| Rate for Payer: Ohio Health Group HMO |
$252.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.50
|
| Rate for Payer: PHCS Commercial |
$323.61
|
| Rate for Payer: United Healthcare All Payer |
$296.64
|
|
|
AVITENE(MICRO COLL HEMO)35 1EA
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
NDC 53276101009
|
| Hospital Charge Code |
27000237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.60
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
AVITENE(MICRO COLL HEMO)35 1EA
|
Facility
|
IP
|
$337.09
|
|
| Hospital Charge Code |
27000237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.82 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$259.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.93
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cigna Commercial |
$279.78
|
| Rate for Payer: First Health Commercial |
$320.24
|
| Rate for Payer: Humana Commercial |
$286.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.64
|
| Rate for Payer: Ohio Health Group HMO |
$252.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.50
|
| Rate for Payer: PHCS Commercial |
$323.61
|
| Rate for Payer: United Healthcare All Payer |
$296.64
|
|
|
AVITENE POWDER
|
Facility
|
IP
|
$337.09
|
|
| Hospital Charge Code |
27000236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.82 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$259.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.93
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cigna Commercial |
$279.78
|
| Rate for Payer: First Health Commercial |
$320.24
|
| Rate for Payer: Humana Commercial |
$286.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.64
|
| Rate for Payer: Ohio Health Group HMO |
$252.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.50
|
| Rate for Payer: PHCS Commercial |
$323.61
|
| Rate for Payer: United Healthcare All Payer |
$296.64
|
|
|
AVITENE POWDER
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
NDC 53276101002
|
| Hospital Charge Code |
27000236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem Medicaid |
$123.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Humana KY Medicaid |
$123.80
|
| Rate for Payer: Kentucky WC Medicaid |
$125.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.60
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
AVITENE POWDER
|
Facility
|
OP
|
$337.09
|
|
| Hospital Charge Code |
27000236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.82 |
| Max. Negotiated Rate |
$323.61 |
| Rate for Payer: Aetna Commercial |
$259.56
|
| Rate for Payer: Anthem Medicaid |
$115.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.93
|
| Rate for Payer: Cash Price |
$168.54
|
| Rate for Payer: Cigna Commercial |
$279.78
|
| Rate for Payer: First Health Commercial |
$320.24
|
| Rate for Payer: Humana Commercial |
$286.53
|
| Rate for Payer: Humana KY Medicaid |
$115.93
|
| Rate for Payer: Kentucky WC Medicaid |
$117.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.64
|
| Rate for Payer: Ohio Health Group HMO |
$252.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.50
|
| Rate for Payer: PHCS Commercial |
$323.61
|
| Rate for Payer: United Healthcare All Payer |
$296.64
|
|
|
AVITENE POWDER
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
NDC 53276101002
|
| Hospital Charge Code |
27000236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.60
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
AVODART (DUTASTERIDE) 0.5MG
|
Facility
|
OP
|
$4.57
|
|
|
Service Code
|
NDC 60505387703
|
| Hospital Charge Code |
25000297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem Medicaid |
$1.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Humana KY Medicaid |
$1.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
AVODART (DUTASTERIDE) 0.5MG
|
Facility
|
IP
|
$4.57
|
|
|
Service Code
|
NDC 60505387703
|
| Hospital Charge Code |
25000297
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
AV OPEN UPPER ARM
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36819
|
| Hospital Charge Code |
76101505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.99 |
| Max. Negotiated Rate |
$1,174.08 |
| Rate for Payer: Aetna Commercial |
$941.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$953.94
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cigna Commercial |
$1,015.09
|
| Rate for Payer: First Health Commercial |
$1,161.85
|
| Rate for Payer: Humana Commercial |
$1,039.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,002.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$902.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$917.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.13
|
| Rate for Payer: PHCS Commercial |
$1,174.08
|
| Rate for Payer: United Healthcare All Payer |
$1,076.24
|
|
|
AV OPEN UPPER ARM
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36819
|
| Hospital Charge Code |
76101505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.05 |
| Max. Negotiated Rate |
$1,271.56 |
| Rate for Payer: Aetna Commercial |
$1,271.56
|
| Rate for Payer: Anthem Medicaid |
$612.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,223.00
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cigna Commercial |
$1,210.34
|
| Rate for Payer: Healthspan PPO |
$1,016.73
|
| Rate for Payer: Humana Medicaid |
$612.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,070.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$624.73
|
| Rate for Payer: Molina Healthcare Passport |
$612.48
|
| Rate for Payer: Multiplan PHCS |
$733.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$856.10
|
| Rate for Payer: UHCCP Medicaid |
$428.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$618.60
|
|
|
AV OPEN UPPER ARM
|
Facility
|
OP
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36819
|
| Hospital Charge Code |
76101505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.99 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$941.71
|
| Rate for Payer: Anthem Medicaid |
$420.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$953.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cigna Commercial |
$1,015.09
|
| Rate for Payer: First Health Commercial |
$1,161.85
|
| Rate for Payer: Humana Commercial |
$1,039.55
|
| Rate for Payer: Humana KY Medicaid |
$420.59
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$424.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,002.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$902.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$429.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$917.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.13
|
| Rate for Payer: PHCS Commercial |
$1,174.08
|
| Rate for Payer: United Healthcare All Payer |
$1,076.24
|
|
|
AV OPEN UPPER ARM(P
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36819
|
| Hospital Charge Code |
761P1505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.05 |
| Max. Negotiated Rate |
$1,271.56 |
| Rate for Payer: Aetna Commercial |
$1,271.56
|
| Rate for Payer: Anthem Medicaid |
$612.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,223.00
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cigna Commercial |
$1,210.34
|
| Rate for Payer: Healthspan PPO |
$1,016.73
|
| Rate for Payer: Humana Medicaid |
$612.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,070.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$624.73
|
| Rate for Payer: Molina Healthcare Passport |
$612.48
|
| Rate for Payer: Multiplan PHCS |
$733.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$856.10
|
| Rate for Payer: UHCCP Medicaid |
$428.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$618.60
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
761T0097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.32
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
