|
QUICKANCHOR PLUS 2/0 ETHIBOND
|
Facility
|
IP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
QUICKANCHOR PLUS W/#2 ETHIBOND
|
Facility
|
OP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem Medicaid |
$1,024.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Humana KY Medicaid |
$1,024.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,034.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,044.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
QUICKANCHOR PLUS W/#2 ETHIBOND
|
Facility
|
IP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
QUICK CROSS GC .014 135C
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem Medicaid |
$643.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Humana KY Medicaid |
$643.09
|
| Rate for Payer: Kentucky WC Medicaid |
$649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
QUICK CROSS GC .014 135C
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
QUINAGLUTE (QUIN. G 324MG/1TAB
|
Facility
|
OP
|
$24.25
|
|
|
Service Code
|
NDC 53489014101
|
| Hospital Charge Code |
25001282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Anthem Medicaid |
$8.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.91
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cigna Commercial |
$20.13
|
| Rate for Payer: First Health Commercial |
$23.04
|
| Rate for Payer: Humana Commercial |
$20.61
|
| Rate for Payer: Humana KY Medicaid |
$8.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.34
|
| Rate for Payer: Ohio Health Group HMO |
$18.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.73
|
| Rate for Payer: PHCS Commercial |
$23.28
|
| Rate for Payer: United Healthcare All Payer |
$21.34
|
|
|
QUINAGLUTE (QUIN. G 324MG/1TAB
|
Facility
|
IP
|
$24.25
|
|
|
Service Code
|
NDC 53489014101
|
| Hospital Charge Code |
25001282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.91
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cigna Commercial |
$20.13
|
| Rate for Payer: First Health Commercial |
$23.04
|
| Rate for Payer: Humana Commercial |
$20.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.34
|
| Rate for Payer: Ohio Health Group HMO |
$18.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.73
|
| Rate for Payer: PHCS Commercial |
$23.28
|
| Rate for Payer: United Healthcare All Payer |
$21.34
|
|
|
QUINIDINE SULFATE 200MG/1TAB
|
Facility
|
OP
|
$29.07
|
|
|
Service Code
|
NDC 42806051330
|
| Hospital Charge Code |
25003867
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$27.91 |
| Rate for Payer: Aetna Commercial |
$22.38
|
| Rate for Payer: Anthem Medicaid |
$10.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.67
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cigna Commercial |
$24.13
|
| Rate for Payer: First Health Commercial |
$27.62
|
| Rate for Payer: Humana Commercial |
$24.71
|
| Rate for Payer: Humana KY Medicaid |
$10.00
|
| Rate for Payer: Kentucky WC Medicaid |
$10.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.58
|
| Rate for Payer: Ohio Health Group HMO |
$21.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.06
|
| Rate for Payer: PHCS Commercial |
$27.91
|
| Rate for Payer: United Healthcare All Payer |
$25.58
|
|
|
QUINIDINE SULFATE 200MG/1TAB
|
Facility
|
IP
|
$29.07
|
|
|
Service Code
|
NDC 42806051330
|
| Hospital Charge Code |
25003867
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$27.91 |
| Rate for Payer: Aetna Commercial |
$22.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.67
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cigna Commercial |
$24.13
|
| Rate for Payer: First Health Commercial |
$27.62
|
| Rate for Payer: Humana Commercial |
$24.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.58
|
| Rate for Payer: Ohio Health Group HMO |
$21.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.06
|
| Rate for Payer: PHCS Commercial |
$27.91
|
| Rate for Payer: United Healthcare All Payer |
$25.58
|
|
|
QUINIDINE SULFATE 300MG/1TAB
|
Facility
|
OP
|
$29.72
|
|
|
Service Code
|
NDC 42806051230
|
| Hospital Charge Code |
25003868
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$28.53 |
| Rate for Payer: Aetna Commercial |
$22.88
|
| Rate for Payer: Anthem Medicaid |
$10.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.18
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna Commercial |
$24.67
|
| Rate for Payer: First Health Commercial |
$28.23
|
| Rate for Payer: Humana Commercial |
$25.26
|
| Rate for Payer: Humana KY Medicaid |
$10.22
|
| Rate for Payer: Kentucky WC Medicaid |
$10.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.15
|
| Rate for Payer: Ohio Health Group HMO |
$22.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.51
|
| Rate for Payer: PHCS Commercial |
$28.53
|
| Rate for Payer: United Healthcare All Payer |
$26.15
|
|
|
QUINIDINE SULFATE 300MG/1TAB
|
Facility
|
IP
|
$29.72
|
|
|
Service Code
|
NDC 42806051230
|
| Hospital Charge Code |
25003868
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$28.53 |
| Rate for Payer: Aetna Commercial |
$22.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.18
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna Commercial |
$24.67
|
| Rate for Payer: First Health Commercial |
$28.23
|
| Rate for Payer: Humana Commercial |
$25.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.15
|
| Rate for Payer: Ohio Health Group HMO |
$22.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.51
|
| Rate for Payer: PHCS Commercial |
$28.53
|
| Rate for Payer: United Healthcare All Payer |
$26.15
|
|
|
Q-VAR 40MCG INHALER 10.6 GM
|
Facility
|
OP
|
$5.31
|
|
|
Service Code
|
NDC 59310030240
|
| Hospital Charge Code |
25001285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna Commercial |
$4.09
|
| Rate for Payer: Anthem Medicaid |
$1.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.14
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cigna Commercial |
$4.41
|
| Rate for Payer: First Health Commercial |
$5.04
|
| Rate for Payer: Humana Commercial |
$4.51
|
| Rate for Payer: Humana KY Medicaid |
$1.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.67
|
| Rate for Payer: Ohio Health Group HMO |
$3.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.66
|
| Rate for Payer: PHCS Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Payer |
$4.67
|
|
|
Q-VAR 40MCG INHALER 10.6 GM
|
Facility
|
IP
|
$5.31
|
|
|
Service Code
|
NDC 59310030240
|
| Hospital Charge Code |
25001285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Aetna Commercial |
$4.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.14
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cigna Commercial |
$4.41
|
| Rate for Payer: First Health Commercial |
$5.04
|
| Rate for Payer: Humana Commercial |
$4.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.67
|
| Rate for Payer: Ohio Health Group HMO |
$3.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.66
|
| Rate for Payer: PHCS Commercial |
$5.10
|
| Rate for Payer: United Healthcare All Payer |
$4.67
|
|
|
Q-VAR 80MCG INHALER
|
Facility
|
OP
|
$7.49
|
|
|
Service Code
|
NDC 59310030480
|
| Hospital Charge Code |
25003397
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$7.19 |
| Rate for Payer: Aetna Commercial |
$5.77
|
| Rate for Payer: Anthem Medicaid |
$2.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.84
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cigna Commercial |
$6.22
|
| Rate for Payer: First Health Commercial |
$7.12
|
| Rate for Payer: Humana Commercial |
$6.37
|
| Rate for Payer: Humana KY Medicaid |
$2.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.59
|
| Rate for Payer: Ohio Health Group HMO |
$5.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.17
|
| Rate for Payer: PHCS Commercial |
$7.19
|
| Rate for Payer: United Healthcare All Payer |
$6.59
|
|
|
Q-VAR 80MCG INHALER
|
Facility
|
IP
|
$7.49
|
|
|
Service Code
|
NDC 59310030480
|
| Hospital Charge Code |
25003397
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$7.19 |
| Rate for Payer: Aetna Commercial |
$5.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.84
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cigna Commercial |
$6.22
|
| Rate for Payer: First Health Commercial |
$7.12
|
| Rate for Payer: Humana Commercial |
$6.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.59
|
| Rate for Payer: Ohio Health Group HMO |
$5.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.17
|
| Rate for Payer: PHCS Commercial |
$7.19
|
| Rate for Payer: United Healthcare All Payer |
$6.59
|
|
|
R3 0^+4 XLPE ACET LINER 28*46
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
R3 0^+4 XLPE ACET LINER 28*46
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
R3 0^+4 XLPE ACET LINER 28*48
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
R3 0^+4 XLPE ACET LINER 28*48
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
R3 0^+4 XLPE ACET LINER 28*50
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
R3 0^+4 XLPE ACET LINER 28*50
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
R3 0 DEG 32 MM XLPE MM50
|
Facility
|
OP
|
$10,228.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,068.65 |
| Max. Negotiated Rate |
$9,819.68 |
| Rate for Payer: Aetna Commercial |
$7,876.20
|
| Rate for Payer: Anthem Medicaid |
$3,517.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,978.49
|
| Rate for Payer: Cash Price |
$5,114.41
|
| Rate for Payer: Cigna Commercial |
$8,489.93
|
| Rate for Payer: First Health Commercial |
$9,717.39
|
| Rate for Payer: Humana Commercial |
$8,694.51
|
| Rate for Payer: Humana KY Medicaid |
$3,517.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,553.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,387.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,548.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,068.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,588.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,001.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,671.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,183.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,899.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,057.89
|
| Rate for Payer: PHCS Commercial |
$9,819.68
|
| Rate for Payer: United Healthcare All Payer |
$9,001.37
|
|
|
R3 0 DEG 32 MM XLPE MM50
|
Facility
|
IP
|
$10,228.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,068.65 |
| Max. Negotiated Rate |
$9,819.68 |
| Rate for Payer: Aetna Commercial |
$7,876.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,978.49
|
| Rate for Payer: Cash Price |
$5,114.41
|
| Rate for Payer: Cigna Commercial |
$8,489.93
|
| Rate for Payer: First Health Commercial |
$9,717.39
|
| Rate for Payer: Humana Commercial |
$8,694.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,387.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,548.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,068.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,001.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,671.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,183.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,899.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,057.89
|
| Rate for Payer: PHCS Commercial |
$9,819.68
|
| Rate for Payer: United Healthcare All Payer |
$9,001.37
|
|
|
R3 0 DEG XLPE ACE LINER 32*48
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
R3 0 DEG XLPE ACE LINER 32*48
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
