|
ATIVAN 2MG/ML VL GTT
|
Facility
|
IP
|
$76.56
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
25002219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Aetna Commercial |
$58.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.72
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cigna Commercial |
$63.54
|
| Rate for Payer: First Health Commercial |
$72.73
|
| Rate for Payer: Humana Commercial |
$65.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.37
|
| Rate for Payer: Ohio Health Group HMO |
$57.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.83
|
| Rate for Payer: PHCS Commercial |
$73.50
|
| Rate for Payer: United Healthcare All Payer |
$67.37
|
|
|
ATIVAN 2MG/ML VL GTT
|
Facility
|
OP
|
$76.56
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
25002219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Aetna Commercial |
$58.95
|
| Rate for Payer: Anthem Medicaid |
$26.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.72
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cigna Commercial |
$63.54
|
| Rate for Payer: First Health Commercial |
$72.73
|
| Rate for Payer: Humana Commercial |
$65.08
|
| Rate for Payer: Humana KY Medicaid |
$26.33
|
| Rate for Payer: Kentucky WC Medicaid |
$26.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.37
|
| Rate for Payer: Ohio Health Group HMO |
$57.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.83
|
| Rate for Payer: PHCS Commercial |
$73.50
|
| Rate for Payer: United Healthcare All Payer |
$67.37
|
|
|
ATIVAN (LORAZEPAM) 2MG/1ML
|
Facility
|
OP
|
$76.56
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
25002218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Aetna Commercial |
$58.95
|
| Rate for Payer: Anthem Medicaid |
$26.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.72
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cigna Commercial |
$63.54
|
| Rate for Payer: First Health Commercial |
$72.73
|
| Rate for Payer: Humana Commercial |
$65.08
|
| Rate for Payer: Humana KY Medicaid |
$26.33
|
| Rate for Payer: Kentucky WC Medicaid |
$26.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.37
|
| Rate for Payer: Ohio Health Group HMO |
$57.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.83
|
| Rate for Payer: PHCS Commercial |
$73.50
|
| Rate for Payer: United Healthcare All Payer |
$67.37
|
|
|
ATIVAN (LORAZEPAM) 2MG/1ML
|
Facility
|
IP
|
$76.56
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
25002218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Aetna Commercial |
$58.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.72
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cigna Commercial |
$63.54
|
| Rate for Payer: First Health Commercial |
$72.73
|
| Rate for Payer: Humana Commercial |
$65.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.37
|
| Rate for Payer: Ohio Health Group HMO |
$57.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.83
|
| Rate for Payer: PHCS Commercial |
$73.50
|
| Rate for Payer: United Healthcare All Payer |
$67.37
|
|
|
ATIVAN ORAL 2MG ML LIQUID
|
Facility
|
OP
|
$60.26
|
|
|
Service Code
|
NDC 121077001
|
| Hospital Charge Code |
25000278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Aetna Commercial |
$46.40
|
| Rate for Payer: Anthem Medicaid |
$20.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.00
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna Commercial |
$50.02
|
| Rate for Payer: First Health Commercial |
$57.25
|
| Rate for Payer: Humana Commercial |
$51.22
|
| Rate for Payer: Humana KY Medicaid |
$20.72
|
| Rate for Payer: Kentucky WC Medicaid |
$20.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.03
|
| Rate for Payer: Ohio Health Group HMO |
$45.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.58
|
| Rate for Payer: PHCS Commercial |
$57.85
|
| Rate for Payer: United Healthcare All Payer |
$53.03
|
|
|
ATIVAN ORAL 2MG ML LIQUID
|
Facility
|
IP
|
$60.26
|
|
|
Service Code
|
NDC 121077001
|
| Hospital Charge Code |
25000278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$57.85 |
| Rate for Payer: Aetna Commercial |
$46.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.00
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cigna Commercial |
$50.02
|
| Rate for Payer: First Health Commercial |
$57.25
|
| Rate for Payer: Humana Commercial |
$51.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.03
|
| Rate for Payer: Ohio Health Group HMO |
$45.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.58
|
| Rate for Payer: PHCS Commercial |
$57.85
|
| Rate for Payer: United Healthcare All Payer |
$53.03
|
|
|
ATLAS 14*2
|
Facility
|
IP
|
$3,237.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$3,108.00 |
| Rate for Payer: Aetna Commercial |
$2,492.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,525.25
|
| Rate for Payer: Cash Price |
$1,618.75
|
| Rate for Payer: Cigna Commercial |
$2,687.12
|
| Rate for Payer: First Health Commercial |
$3,075.62
|
| Rate for Payer: Humana Commercial |
$2,751.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,654.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,389.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,849.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,428.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,590.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,816.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,233.88
|
| Rate for Payer: PHCS Commercial |
$3,108.00
|
| Rate for Payer: United Healthcare All Payer |
$2,849.00
|
|
|
ATLAS 14*2
|
Facility
|
OP
|
$3,237.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$3,108.00 |
| Rate for Payer: Aetna Commercial |
$2,492.88
|
| Rate for Payer: Anthem Medicaid |
$1,113.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,525.25
|
| Rate for Payer: Cash Price |
$1,618.75
|
| Rate for Payer: Cigna Commercial |
$2,687.12
|
| Rate for Payer: First Health Commercial |
$3,075.62
|
| Rate for Payer: Humana Commercial |
$2,751.88
|
| Rate for Payer: Humana KY Medicaid |
$1,113.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,124.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,654.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,389.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,135.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,849.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,428.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,590.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,816.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,233.88
|
| Rate for Payer: PHCS Commercial |
$3,108.00
|
| Rate for Payer: United Healthcare All Payer |
$2,849.00
|
|
|
ATLAS 14*4
|
Facility
|
IP
|
$3,237.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$3,108.00 |
| Rate for Payer: Aetna Commercial |
$2,492.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,525.25
|
| Rate for Payer: Cash Price |
$1,618.75
|
| Rate for Payer: Cigna Commercial |
$2,687.12
|
| Rate for Payer: First Health Commercial |
$3,075.62
|
| Rate for Payer: Humana Commercial |
$2,751.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,654.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,389.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,849.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,428.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,590.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,816.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,233.88
|
| Rate for Payer: PHCS Commercial |
$3,108.00
|
| Rate for Payer: United Healthcare All Payer |
$2,849.00
|
|
|
ATLAS 14*4
|
Facility
|
OP
|
$3,237.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$3,108.00 |
| Rate for Payer: Aetna Commercial |
$2,492.88
|
| Rate for Payer: Anthem Medicaid |
$1,113.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,525.25
|
| Rate for Payer: Cash Price |
$1,618.75
|
| Rate for Payer: Cigna Commercial |
$2,687.12
|
| Rate for Payer: First Health Commercial |
$3,075.62
|
| Rate for Payer: Humana Commercial |
$2,751.88
|
| Rate for Payer: Humana KY Medicaid |
$1,113.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,124.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,654.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,389.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,135.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,849.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,428.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,590.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,816.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,233.88
|
| Rate for Payer: PHCS Commercial |
$3,108.00
|
| Rate for Payer: United Healthcare All Payer |
$2,849.00
|
|
|
ATLAS 16*2
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna Commercial |
$2,579.50
|
| Rate for Payer: Anthem Medicaid |
$1,152.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,613.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,780.50
|
| Rate for Payer: First Health Commercial |
$3,182.50
|
| Rate for Payer: Humana Commercial |
$2,847.50
|
| Rate for Payer: Humana KY Medicaid |
$1,152.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,163.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,747.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,175.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,948.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.50
|
| Rate for Payer: PHCS Commercial |
$3,216.00
|
| Rate for Payer: United Healthcare All Payer |
$2,948.00
|
|
|
ATLAS 16*2
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna Commercial |
$2,579.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,613.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,780.50
|
| Rate for Payer: First Health Commercial |
$3,182.50
|
| Rate for Payer: Humana Commercial |
$2,847.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,747.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,948.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.50
|
| Rate for Payer: PHCS Commercial |
$3,216.00
|
| Rate for Payer: United Healthcare All Payer |
$2,948.00
|
|
|
ATLAS 16*4
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna Commercial |
$2,579.50
|
| Rate for Payer: Anthem Medicaid |
$1,152.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,613.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,780.50
|
| Rate for Payer: First Health Commercial |
$3,182.50
|
| Rate for Payer: Humana Commercial |
$2,847.50
|
| Rate for Payer: Humana KY Medicaid |
$1,152.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,163.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,747.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,175.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,948.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.50
|
| Rate for Payer: PHCS Commercial |
$3,216.00
|
| Rate for Payer: United Healthcare All Payer |
$2,948.00
|
|
|
ATLAS 16*4
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna Commercial |
$2,579.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,613.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,780.50
|
| Rate for Payer: First Health Commercial |
$3,182.50
|
| Rate for Payer: Humana Commercial |
$2,847.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,747.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,948.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.50
|
| Rate for Payer: PHCS Commercial |
$3,216.00
|
| Rate for Payer: United Healthcare All Payer |
$2,948.00
|
|
|
ATLAS 18*2
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna Commercial |
$2,579.50
|
| Rate for Payer: Anthem Medicaid |
$1,152.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,613.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,780.50
|
| Rate for Payer: First Health Commercial |
$3,182.50
|
| Rate for Payer: Humana Commercial |
$2,847.50
|
| Rate for Payer: Humana KY Medicaid |
$1,152.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,163.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,747.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,175.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,948.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.50
|
| Rate for Payer: PHCS Commercial |
$3,216.00
|
| Rate for Payer: United Healthcare All Payer |
$2,948.00
|
|
|
ATLAS 18*2
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna Commercial |
$2,579.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,613.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,780.50
|
| Rate for Payer: First Health Commercial |
$3,182.50
|
| Rate for Payer: Humana Commercial |
$2,847.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,747.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,948.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.50
|
| Rate for Payer: PHCS Commercial |
$3,216.00
|
| Rate for Payer: United Healthcare All Payer |
$2,948.00
|
|
|
ATLAS 18*4
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna Commercial |
$2,579.50
|
| Rate for Payer: Anthem Medicaid |
$1,152.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,613.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,780.50
|
| Rate for Payer: First Health Commercial |
$3,182.50
|
| Rate for Payer: Humana Commercial |
$2,847.50
|
| Rate for Payer: Humana KY Medicaid |
$1,152.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,163.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,747.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,175.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,948.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.50
|
| Rate for Payer: PHCS Commercial |
$3,216.00
|
| Rate for Payer: United Healthcare All Payer |
$2,948.00
|
|
|
ATLAS 18*4
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna Commercial |
$2,579.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,613.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,780.50
|
| Rate for Payer: First Health Commercial |
$3,182.50
|
| Rate for Payer: Humana Commercial |
$2,847.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,747.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,948.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.50
|
| Rate for Payer: PHCS Commercial |
$3,216.00
|
| Rate for Payer: United Healthcare All Payer |
$2,948.00
|
|
|
ATLAS 20*2
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ATLAS 20*2
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ATLAS 20*4
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ATLAS 20*4
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ATOPOBIUM VAGINAE PCR
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$285.12 |
| Rate for Payer: Aetna Commercial |
$228.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.49
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$246.51
|
| Rate for Payer: First Health Commercial |
$282.15
|
| Rate for Payer: Humana Commercial |
$252.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$243.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$261.36
|
| Rate for Payer: Ohio Health Group HMO |
$222.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.93
|
| Rate for Payer: PHCS Commercial |
$285.12
|
| Rate for Payer: United Healthcare All Payer |
$261.36
|
|
|
ATOPOBIUM VAGINAE PCR
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$285.12 |
| Rate for Payer: Aetna Commercial |
$228.69
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$246.51
|
| Rate for Payer: First Health Commercial |
$282.15
|
| Rate for Payer: Humana Commercial |
$252.45
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$243.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$261.36
|
| Rate for Payer: Ohio Health Group HMO |
$222.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.93
|
| Rate for Payer: PHCS Commercial |
$285.12
|
| Rate for Payer: United Healthcare All Payer |
$261.36
|
|
|
ATOPOBIUM VAGINAE PCR
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$178.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$103.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
