|
ARMIDEX (ANASTROZOLE) 1MG TAB
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 68001015504
|
| Hospital Charge Code |
25000250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Anthem Medicaid |
$0.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.13
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cigna Commercial |
$2.27
|
| Rate for Payer: First Health Commercial |
$2.59
|
| Rate for Payer: Humana Commercial |
$2.32
|
| Rate for Payer: Humana KY Medicaid |
$0.94
|
| Rate for Payer: Kentucky WC Medicaid |
$0.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.40
|
| Rate for Payer: Ohio Health Group HMO |
$2.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.88
|
| Rate for Payer: PHCS Commercial |
$2.62
|
| Rate for Payer: United Healthcare All Payer |
$2.40
|
|
|
ARMIDEX (ANASTROZOLE) 1MG TAB
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 68001015504
|
| Hospital Charge Code |
25000250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.13
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cigna Commercial |
$2.27
|
| Rate for Payer: First Health Commercial |
$2.59
|
| Rate for Payer: Humana Commercial |
$2.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.40
|
| Rate for Payer: Ohio Health Group HMO |
$2.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.88
|
| Rate for Payer: PHCS Commercial |
$2.62
|
| Rate for Payer: United Healthcare All Payer |
$2.40
|
|
|
AR MOD CATH 5F
|
Facility
|
IP
|
$806.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.88 |
| Max. Negotiated Rate |
$774.00 |
| Rate for Payer: Aetna Commercial |
$620.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$628.88
|
| Rate for Payer: Cash Price |
$403.12
|
| Rate for Payer: Cigna Commercial |
$669.19
|
| Rate for Payer: First Health Commercial |
$765.94
|
| Rate for Payer: Humana Commercial |
$685.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$661.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$595.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$709.50
|
| Rate for Payer: Ohio Health Group HMO |
$604.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.31
|
| Rate for Payer: PHCS Commercial |
$774.00
|
| Rate for Payer: United Healthcare All Payer |
$709.50
|
|
|
AR MOD CATH 5F
|
Facility
|
OP
|
$806.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.88 |
| Max. Negotiated Rate |
$774.00 |
| Rate for Payer: Aetna Commercial |
$620.81
|
| Rate for Payer: Anthem Medicaid |
$277.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$628.88
|
| Rate for Payer: Cash Price |
$403.12
|
| Rate for Payer: Cigna Commercial |
$669.19
|
| Rate for Payer: First Health Commercial |
$765.94
|
| Rate for Payer: Humana Commercial |
$685.31
|
| Rate for Payer: Humana KY Medicaid |
$277.27
|
| Rate for Payer: Kentucky WC Medicaid |
$280.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$661.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$595.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$709.50
|
| Rate for Payer: Ohio Health Group HMO |
$604.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.31
|
| Rate for Payer: PHCS Commercial |
$774.00
|
| Rate for Payer: United Healthcare All Payer |
$709.50
|
|
|
ARMOUR THYROID 15MG TABLET
|
Facility
|
IP
|
$4.79
|
|
|
Service Code
|
NDC 42192032701
|
| Hospital Charge Code |
25000251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.55
|
| Rate for Payer: Humana Commercial |
$4.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| Rate for Payer: PHCS Commercial |
$4.60
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
ARMOUR THYROID 15MG TABLET
|
Facility
|
OP
|
$4.79
|
|
|
Service Code
|
NDC 42192032701
|
| Hospital Charge Code |
25000251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.55
|
| Rate for Payer: Humana Commercial |
$4.07
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| Rate for Payer: PHCS Commercial |
$4.60
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
ARMOUR THYROID 30 MG TABLET
|
Facility
|
IP
|
$4.89
|
|
|
Service Code
|
NDC 42192032901
|
| Hospital Charge Code |
25000252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.06
|
| Rate for Payer: First Health Commercial |
$4.65
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.30
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.37
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
|
|
ARMOUR THYROID 30 MG TABLET
|
Facility
|
OP
|
$4.89
|
|
|
Service Code
|
NDC 42192032901
|
| Hospital Charge Code |
25000252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem Medicaid |
$1.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.06
|
| Rate for Payer: First Health Commercial |
$4.65
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Humana KY Medicaid |
$1.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.30
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.37
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
|
|
Arms - Full Laser Hair Removal
|
Professional
|
Both
|
$425.00
|
|
| Hospital Charge Code |
22200218
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
|
|
Arms-Full Lsr HairRem-PP#1 50%
|
Professional
|
Both
|
$543.00
|
|
| Hospital Charge Code |
22200219
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$190.05 |
| Max. Negotiated Rate |
$380.10 |
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Multiplan PHCS |
$325.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$380.10
|
| Rate for Payer: UHCCP Medicaid |
$190.05
|
|
|
Arms-FulLsr HairRem-PP#2/3 25%
|
Professional
|
Both
|
$270.00
|
|
| Hospital Charge Code |
22200475
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.00
|
| Rate for Payer: UHCCP Medicaid |
$94.50
|
|
|
Arms Laser Hair Removal
|
Professional
|
Both
|
$225.00
|
|
| Hospital Charge Code |
22200181
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
|
|
Arms Laser Hair Removal
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
22200181
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.25
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
Arms Laser Hair Removal
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
22200181
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem Medicaid |
$77.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Humana KY Medicaid |
$77.38
|
| Rate for Payer: Kentucky WC Medicaid |
$78.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.25
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
Arms LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$287.00
|
|
| Hospital Charge Code |
22200345
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$200.90 |
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Multiplan PHCS |
$172.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$200.90
|
| Rate for Payer: UHCCP Medicaid |
$100.45
|
|
|
Arms LsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$143.00
|
|
| Hospital Charge Code |
22200461
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$100.10 |
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Multiplan PHCS |
$85.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.10
|
| Rate for Payer: UHCCP Medicaid |
$50.05
|
|
|
AROMASIN(EXEMESTANE) 25MG TAB
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
NDC 59762285801
|
| Hospital Charge Code |
25000253
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$7.01
|
| Rate for Payer: Anthem Medicaid |
$3.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.10
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cigna Commercial |
$7.55
|
| Rate for Payer: First Health Commercial |
$8.64
|
| Rate for Payer: Humana Commercial |
$7.74
|
| Rate for Payer: Humana KY Medicaid |
$3.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.01
|
| Rate for Payer: Ohio Health Group HMO |
$6.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.28
|
| Rate for Payer: PHCS Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Payer |
$8.01
|
|
|
AROMASIN(EXEMESTANE) 25MG TAB
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
NDC 59762285801
|
| Hospital Charge Code |
25000253
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$7.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.10
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cigna Commercial |
$7.55
|
| Rate for Payer: First Health Commercial |
$8.64
|
| Rate for Payer: Humana Commercial |
$7.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.01
|
| Rate for Payer: Ohio Health Group HMO |
$6.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.28
|
| Rate for Payer: PHCS Commercial |
$8.74
|
| Rate for Payer: United Healthcare All Payer |
$8.01
|
|
|
AROMATIC AMMONIA VAPOROLE 1EA
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 39822990002
|
| Hospital Charge Code |
25000254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: First Health Commercial |
$4.41
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.08
|
| Rate for Payer: Ohio Health Group HMO |
$3.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.20
|
| Rate for Payer: PHCS Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Payer |
$4.08
|
|
|
AROMATIC AMMONIA VAPOROLE 1EA
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 39822990002
|
| Hospital Charge Code |
25000254
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: First Health Commercial |
$4.41
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.08
|
| Rate for Payer: Ohio Health Group HMO |
$3.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.20
|
| Rate for Payer: PHCS Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Payer |
$4.08
|
|
|
ARROW 4.5FR SNGL PICC W/CHLORA
|
Facility
|
IP
|
$2,212.76
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.83 |
| Max. Negotiated Rate |
$2,124.25 |
| Rate for Payer: Aetna Commercial |
$1,703.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,725.95
|
| Rate for Payer: Cash Price |
$1,106.38
|
| Rate for Payer: Cigna Commercial |
$1,836.59
|
| Rate for Payer: First Health Commercial |
$2,102.12
|
| Rate for Payer: Humana Commercial |
$1,880.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,814.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,633.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,947.23
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,770.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,925.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.80
|
| Rate for Payer: PHCS Commercial |
$2,124.25
|
| Rate for Payer: United Healthcare All Payer |
$1,947.23
|
|
|
ARROW 4.5FR SNGL PICC W/CHLORA
|
Facility
|
OP
|
$2,212.76
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.83 |
| Max. Negotiated Rate |
$2,124.25 |
| Rate for Payer: Aetna Commercial |
$1,703.83
|
| Rate for Payer: Anthem Medicaid |
$760.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,725.95
|
| Rate for Payer: Cash Price |
$1,106.38
|
| Rate for Payer: Cigna Commercial |
$1,836.59
|
| Rate for Payer: First Health Commercial |
$2,102.12
|
| Rate for Payer: Humana Commercial |
$1,880.85
|
| Rate for Payer: Humana KY Medicaid |
$760.97
|
| Rate for Payer: Kentucky WC Medicaid |
$768.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,814.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,633.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$776.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,947.23
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,770.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,925.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.80
|
| Rate for Payer: PHCS Commercial |
$2,124.25
|
| Rate for Payer: United Healthcare All Payer |
$1,947.23
|
|
|
ARROW 5.5FR DUAL PICC W/CHLORA
|
Facility
|
OP
|
$5,607.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,682.25 |
| Max. Negotiated Rate |
$5,383.20 |
| Rate for Payer: Aetna Commercial |
$4,317.77
|
| Rate for Payer: Anthem Medicaid |
$1,928.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,373.85
|
| Rate for Payer: Cash Price |
$2,803.75
|
| Rate for Payer: Cigna Commercial |
$4,654.23
|
| Rate for Payer: First Health Commercial |
$5,327.12
|
| Rate for Payer: Humana Commercial |
$4,766.38
|
| Rate for Payer: Humana KY Medicaid |
$1,928.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,948.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,598.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,138.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,967.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,934.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,205.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,878.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,869.18
|
| Rate for Payer: PHCS Commercial |
$5,383.20
|
| Rate for Payer: United Healthcare All Payer |
$4,934.60
|
|
|
ARROW 5.5FR DUAL PICC W/CHLORA
|
Facility
|
IP
|
$5,607.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,682.25 |
| Max. Negotiated Rate |
$5,383.20 |
| Rate for Payer: Aetna Commercial |
$4,317.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,373.85
|
| Rate for Payer: Cash Price |
$2,803.75
|
| Rate for Payer: Cigna Commercial |
$4,654.23
|
| Rate for Payer: First Health Commercial |
$5,327.12
|
| Rate for Payer: Humana Commercial |
$4,766.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,598.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,138.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,934.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,205.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,486.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,878.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,869.18
|
| Rate for Payer: PHCS Commercial |
$5,383.20
|
| Rate for Payer: United Healthcare All Payer |
$4,934.60
|
|
|
ART 3.5 GUIDE 8FR
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.50 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem Medicaid |
$383.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Humana KY Medicaid |
$383.45
|
| Rate for Payer: Kentucky WC Medicaid |
$387.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$769.35
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
