|
AS INVRS HUM CUP +9MM DEG RETR
|
Facility
|
IP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
|
AS INVRS HUM CUP +9MM DEG RETR
|
Facility
|
OP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem Medicaid |
$2,969.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Humana KY Medicaid |
$2,969.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,000.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,029.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
|
AS INVRS HUM PE-INLAY0MM36MMHD
|
Facility
|
IP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INVRS HUM PE-INLAY0MM36MMHD
|
Facility
|
OP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem Medicaid |
$2,489.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Humana KY Medicaid |
$2,489.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,539.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INVRS HUM PE-INLAY 3MM 36MM
|
Facility
|
IP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INVRS HUM PE-INLAY 3MM 36MM
|
Facility
|
OP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem Medicaid |
$2,489.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Humana KY Medicaid |
$2,489.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,539.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INVRS HUM PE-INLAY 6MM 36MM
|
Facility
|
OP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem Medicaid |
$2,489.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Humana KY Medicaid |
$2,489.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,539.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INVRS HUM PE-INLAY 6MM 36MM
|
Facility
|
IP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
ASMANEX 220MCG 60 MDI
|
Facility
|
IP
|
$535.90
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.77 |
| Max. Negotiated Rate |
$514.46 |
| Rate for Payer: Aetna Commercial |
$412.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.00
|
| Rate for Payer: Cash Price |
$267.95
|
| Rate for Payer: Cigna Commercial |
$444.80
|
| Rate for Payer: First Health Commercial |
$509.11
|
| Rate for Payer: Humana Commercial |
$455.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$439.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.59
|
| Rate for Payer: Ohio Health Group HMO |
$401.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.77
|
| Rate for Payer: PHCS Commercial |
$514.46
|
| Rate for Payer: United Healthcare All Payer |
$471.59
|
|
|
ASMANEX 220MCG 60 MDI
|
Facility
|
OP
|
$535.90
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.77 |
| Max. Negotiated Rate |
$514.46 |
| Rate for Payer: Aetna Commercial |
$412.64
|
| Rate for Payer: Anthem Medicaid |
$184.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.00
|
| Rate for Payer: Cash Price |
$267.95
|
| Rate for Payer: Cigna Commercial |
$444.80
|
| Rate for Payer: First Health Commercial |
$509.11
|
| Rate for Payer: Humana Commercial |
$455.51
|
| Rate for Payer: Humana KY Medicaid |
$184.30
|
| Rate for Payer: Kentucky WC Medicaid |
$186.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$439.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.59
|
| Rate for Payer: Ohio Health Group HMO |
$401.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.77
|
| Rate for Payer: PHCS Commercial |
$514.46
|
| Rate for Payer: United Healthcare All Payer |
$471.59
|
|
|
ASMANEX 220MCG INHALER
|
Facility
|
OP
|
$189.80
|
|
|
Service Code
|
NDC 78206011403
|
| Hospital Charge Code |
25002852
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$182.21 |
| Rate for Payer: Aetna Commercial |
$146.15
|
| Rate for Payer: Anthem Medicaid |
$65.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.04
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cigna Commercial |
$157.53
|
| Rate for Payer: First Health Commercial |
$180.31
|
| Rate for Payer: Humana Commercial |
$161.33
|
| Rate for Payer: Humana KY Medicaid |
$65.27
|
| Rate for Payer: Kentucky WC Medicaid |
$65.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.02
|
| Rate for Payer: Ohio Health Group HMO |
$142.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.96
|
| Rate for Payer: PHCS Commercial |
$182.21
|
| Rate for Payer: United Healthcare All Payer |
$167.02
|
|
|
ASMANEX 220MCG INHALER
|
Facility
|
IP
|
$189.80
|
|
|
Service Code
|
NDC 78206011403
|
| Hospital Charge Code |
25002852
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$182.21 |
| Rate for Payer: Aetna Commercial |
$146.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.04
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cigna Commercial |
$157.53
|
| Rate for Payer: First Health Commercial |
$180.31
|
| Rate for Payer: Humana Commercial |
$161.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.02
|
| Rate for Payer: Ohio Health Group HMO |
$142.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.96
|
| Rate for Payer: PHCS Commercial |
$182.21
|
| Rate for Payer: United Healthcare All Payer |
$167.02
|
|
|
ASNIS MCRO 2.0 KWIRE 0.8*100MM
|
Facility
|
OP
|
$563.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.12 |
| Max. Negotiated Rate |
$541.17 |
| Rate for Payer: Aetna Commercial |
$434.06
|
| Rate for Payer: Anthem Medicaid |
$193.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.70
|
| Rate for Payer: Cash Price |
$281.86
|
| Rate for Payer: Cigna Commercial |
$467.89
|
| Rate for Payer: First Health Commercial |
$535.53
|
| Rate for Payer: Humana Commercial |
$479.16
|
| Rate for Payer: Humana KY Medicaid |
$193.86
|
| Rate for Payer: Kentucky WC Medicaid |
$195.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.07
|
| Rate for Payer: Ohio Health Group HMO |
$422.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$450.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$388.97
|
| Rate for Payer: PHCS Commercial |
$541.17
|
| Rate for Payer: United Healthcare All Payer |
$496.07
|
|
|
ASNIS MCRO 2.0 KWIRE 0.8*100MM
|
Facility
|
IP
|
$563.72
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.12 |
| Max. Negotiated Rate |
$541.17 |
| Rate for Payer: Aetna Commercial |
$434.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.70
|
| Rate for Payer: Cash Price |
$281.86
|
| Rate for Payer: Cigna Commercial |
$467.89
|
| Rate for Payer: First Health Commercial |
$535.53
|
| Rate for Payer: Humana Commercial |
$479.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.07
|
| Rate for Payer: Ohio Health Group HMO |
$422.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$450.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$388.97
|
| Rate for Payer: PHCS Commercial |
$541.17
|
| Rate for Payer: United Healthcare All Payer |
$496.07
|
|
|
AS NUT FOR FEM STEM NEUTRAL
|
Facility
|
OP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem Medicaid |
$1,860.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Humana KY Medicaid |
$1,860.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,879.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
AS NUT FOR FEM STEM NEUTRAL
|
Facility
|
IP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
ASP BIOP NEEDL SHTH NA-1C/2C
|
Facility
|
IP
|
$1,682.77
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.83 |
| Max. Negotiated Rate |
$1,615.46 |
| Rate for Payer: Aetna Commercial |
$1,295.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,312.56
|
| Rate for Payer: Cash Price |
$841.39
|
| Rate for Payer: Cigna Commercial |
$1,396.70
|
| Rate for Payer: First Health Commercial |
$1,598.63
|
| Rate for Payer: Humana Commercial |
$1,430.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,379.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,241.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,480.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,262.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,346.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,464.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,161.11
|
| Rate for Payer: PHCS Commercial |
$1,615.46
|
| Rate for Payer: United Healthcare All Payer |
$1,480.84
|
|
|
ASP BIOP NEEDL SHTH NA-1C/2C
|
Facility
|
OP
|
$1,682.77
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.83 |
| Max. Negotiated Rate |
$1,615.46 |
| Rate for Payer: Aetna Commercial |
$1,295.73
|
| Rate for Payer: Anthem Medicaid |
$578.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,312.56
|
| Rate for Payer: Cash Price |
$841.39
|
| Rate for Payer: Cigna Commercial |
$1,396.70
|
| Rate for Payer: First Health Commercial |
$1,598.63
|
| Rate for Payer: Humana Commercial |
$1,430.35
|
| Rate for Payer: Humana KY Medicaid |
$578.70
|
| Rate for Payer: Kentucky WC Medicaid |
$584.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,379.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,241.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$590.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,480.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,262.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,346.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,464.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,161.11
|
| Rate for Payer: PHCS Commercial |
$1,615.46
|
| Rate for Payer: United Healthcare All Payer |
$1,480.84
|
|
|
ASPERGILLUS FUMIGATUS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
ASPERGILLUS FUMIGATUS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
ASPHERE HEAD 11/13 36 0
|
Facility
|
IP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 36 0
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 36 -3
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 36 -3
|
Facility
|
IP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 36 3
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
