|
STEALTH 360 1.25*145
|
Facility
|
IP
|
$16,422.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,134.86 |
| Max. Negotiated Rate |
$15,765.12 |
| Rate for Payer: Aetna Commercial |
$12,644.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,809.16
|
| Rate for Payer: Cash Price |
$8,211.00
|
| Rate for Payer: Cigna Commercial |
$13,630.26
|
| Rate for Payer: First Health Commercial |
$15,600.90
|
| Rate for Payer: Humana Commercial |
$13,958.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,466.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,119.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,926.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,451.36
|
| Rate for Payer: Ohio Health Group HMO |
$12,316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,284.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,134.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.82
|
| Rate for Payer: PHCS Commercial |
$15,765.12
|
| Rate for Payer: United Healthcare All Payer |
$14,451.36
|
|
|
STEALTH 360 1.25*145
|
Facility
|
OP
|
$16,422.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,134.86 |
| Max. Negotiated Rate |
$15,765.12 |
| Rate for Payer: Aetna Commercial |
$12,644.94
|
| Rate for Payer: Anthem Medicaid |
$5,647.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,809.16
|
| Rate for Payer: Cash Price |
$8,211.00
|
| Rate for Payer: Cigna Commercial |
$13,630.26
|
| Rate for Payer: First Health Commercial |
$15,600.90
|
| Rate for Payer: Humana Commercial |
$13,958.70
|
| Rate for Payer: Humana KY Medicaid |
$5,647.53
|
| Rate for Payer: Kentucky WC Medicaid |
$5,705.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,466.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,119.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,926.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,760.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,451.36
|
| Rate for Payer: Ohio Health Group HMO |
$12,316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,284.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,134.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.82
|
| Rate for Payer: PHCS Commercial |
$15,765.12
|
| Rate for Payer: United Healthcare All Payer |
$14,451.36
|
|
|
STEALTH 360 1.50*145
|
Facility
|
OP
|
$17,142.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.46 |
| Max. Negotiated Rate |
$16,456.32 |
| Rate for Payer: Aetna Commercial |
$13,199.34
|
| Rate for Payer: Anthem Medicaid |
$5,895.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,370.76
|
| Rate for Payer: Cash Price |
$8,571.00
|
| Rate for Payer: Cigna Commercial |
$14,227.86
|
| Rate for Payer: First Health Commercial |
$16,284.90
|
| Rate for Payer: Humana Commercial |
$14,570.70
|
| Rate for Payer: Humana KY Medicaid |
$5,895.13
|
| Rate for Payer: Kentucky WC Medicaid |
$5,955.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,056.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,650.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,142.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,013.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,084.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,856.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,428.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,228.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,314.02
|
| Rate for Payer: PHCS Commercial |
$16,456.32
|
| Rate for Payer: United Healthcare All Payer |
$15,084.96
|
|
|
STEALTH 360 1.50*145
|
Facility
|
IP
|
$17,142.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.46 |
| Max. Negotiated Rate |
$16,456.32 |
| Rate for Payer: Aetna Commercial |
$13,199.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,370.76
|
| Rate for Payer: Cash Price |
$8,571.00
|
| Rate for Payer: Cigna Commercial |
$14,227.86
|
| Rate for Payer: First Health Commercial |
$16,284.90
|
| Rate for Payer: Humana Commercial |
$14,570.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,056.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,650.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,142.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,084.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,856.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,428.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,228.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,314.02
|
| Rate for Payer: PHCS Commercial |
$16,456.32
|
| Rate for Payer: United Healthcare All Payer |
$15,084.96
|
|
|
STEALTH 360 2.0*145
|
Facility
|
IP
|
$17,142.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.46 |
| Max. Negotiated Rate |
$16,456.32 |
| Rate for Payer: Aetna Commercial |
$13,199.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,370.76
|
| Rate for Payer: Cash Price |
$8,571.00
|
| Rate for Payer: Cigna Commercial |
$14,227.86
|
| Rate for Payer: First Health Commercial |
$16,284.90
|
| Rate for Payer: Humana Commercial |
$14,570.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,056.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,650.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,142.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,084.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,856.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,428.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,228.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,314.02
|
| Rate for Payer: PHCS Commercial |
$16,456.32
|
| Rate for Payer: United Healthcare All Payer |
$15,084.96
|
|
|
STEALTH 360 2.0*145
|
Facility
|
OP
|
$17,142.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.46 |
| Max. Negotiated Rate |
$16,456.32 |
| Rate for Payer: Aetna Commercial |
$13,199.34
|
| Rate for Payer: Anthem Medicaid |
$5,895.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,370.76
|
| Rate for Payer: Cash Price |
$8,571.00
|
| Rate for Payer: Cigna Commercial |
$14,227.86
|
| Rate for Payer: First Health Commercial |
$16,284.90
|
| Rate for Payer: Humana Commercial |
$14,570.70
|
| Rate for Payer: Humana KY Medicaid |
$5,895.13
|
| Rate for Payer: Kentucky WC Medicaid |
$5,955.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,056.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,650.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,142.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,013.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,084.96
|
| Rate for Payer: Ohio Health Group HMO |
$12,856.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,428.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,228.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,314.02
|
| Rate for Payer: PHCS Commercial |
$16,456.32
|
| Rate for Payer: United Healthcare All Payer |
$15,084.96
|
|
|
STEGLATRO 15MG TABLET
|
Facility
|
OP
|
$28.90
|
|
|
Service Code
|
NDC 6536403
|
| Hospital Charge Code |
25003484
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Aetna Commercial |
$22.25
|
| Rate for Payer: Anthem Medicaid |
$9.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.54
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cigna Commercial |
$23.99
|
| Rate for Payer: First Health Commercial |
$27.46
|
| Rate for Payer: Humana Commercial |
$24.56
|
| Rate for Payer: Humana KY Medicaid |
$9.94
|
| Rate for Payer: Kentucky WC Medicaid |
$10.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.43
|
| Rate for Payer: Ohio Health Group HMO |
$21.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.96
|
| Rate for Payer: PHCS Commercial |
$27.74
|
| Rate for Payer: United Healthcare All Payer |
$25.43
|
|
|
STEGLATRO 15MG TABLET
|
Facility
|
IP
|
$28.90
|
|
|
Service Code
|
NDC 6536403
|
| Hospital Charge Code |
25003484
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Aetna Commercial |
$22.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.54
|
| Rate for Payer: Cash Price |
$14.45
|
| Rate for Payer: Cigna Commercial |
$23.99
|
| Rate for Payer: First Health Commercial |
$27.46
|
| Rate for Payer: Humana Commercial |
$24.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.43
|
| Rate for Payer: Ohio Health Group HMO |
$21.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.96
|
| Rate for Payer: PHCS Commercial |
$27.74
|
| Rate for Payer: United Healthcare All Payer |
$25.43
|
|
|
STEINMAN 2MM PIN 9 IN
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
STEINMAN 2MM PIN 9 IN
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem Medicaid |
$252.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana KY Medicaid |
$252.77
|
| Rate for Payer: Kentucky WC Medicaid |
$255.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
STELARA 1MG [45MG/0.5ML]
|
Facility
|
OP
|
$15,671.43
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
25003877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.96 |
| Max. Negotiated Rate |
$15,044.57 |
| Rate for Payer: Aetna Commercial |
$12,067.00
|
| Rate for Payer: Anthem Medicaid |
$5,389.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$153.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,223.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$215.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$207.84
|
| Rate for Payer: Cash Price |
$7,835.72
|
| Rate for Payer: Cash Price |
$7,835.72
|
| Rate for Payer: Cigna Commercial |
$13,007.29
|
| Rate for Payer: First Health Commercial |
$14,887.86
|
| Rate for Payer: Humana Commercial |
$13,320.72
|
| Rate for Payer: Humana KY Medicaid |
$5,389.40
|
| Rate for Payer: Humana Medicare Advantage |
$153.96
|
| Rate for Payer: Kentucky WC Medicaid |
$5,444.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,850.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,565.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,497.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,790.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,753.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,134.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,037.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,858.14
|
| Rate for Payer: PHCS Commercial |
$15,044.57
|
| Rate for Payer: United Healthcare All Payer |
$13,790.86
|
|
|
STELARA 1MG [45MG/0.5ML]
|
Facility
|
IP
|
$15,671.43
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
25003877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,037.29 |
| Max. Negotiated Rate |
$15,044.57 |
| Rate for Payer: Aetna Commercial |
$12,067.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,223.72
|
| Rate for Payer: Cash Price |
$7,835.72
|
| Rate for Payer: Cigna Commercial |
$13,007.29
|
| Rate for Payer: First Health Commercial |
$14,887.86
|
| Rate for Payer: Humana Commercial |
$13,320.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,850.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,565.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,701.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,790.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,753.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,134.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,037.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,858.14
|
| Rate for Payer: PHCS Commercial |
$15,044.57
|
| Rate for Payer: United Healthcare All Payer |
$13,790.86
|
|
|
STELARA 1MG[90 MG SYRINGE]
|
Facility
|
IP
|
$29,592.85
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
25002402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,847.07 |
| Max. Negotiated Rate |
$28,409.14 |
| Rate for Payer: Aetna Commercial |
$22,786.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,082.42
|
| Rate for Payer: Cash Price |
$14,796.42
|
| Rate for Payer: Cigna Commercial |
$24,562.07
|
| Rate for Payer: First Health Commercial |
$28,113.21
|
| Rate for Payer: Humana Commercial |
$25,153.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,266.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,839.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,877.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,041.71
|
| Rate for Payer: Ohio Health Group HMO |
$22,194.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,918.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,847.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,173.78
|
| Rate for Payer: PHCS Commercial |
$28,409.14
|
| Rate for Payer: United Healthcare All Payer |
$26,041.71
|
|
|
STELARA 1MG[90 MG SYRINGE]
|
Facility
|
OP
|
$29,592.85
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
25002402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.96 |
| Max. Negotiated Rate |
$28,409.14 |
| Rate for Payer: Aetna Commercial |
$22,786.49
|
| Rate for Payer: Anthem Medicaid |
$10,176.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$153.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,082.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$215.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$207.84
|
| Rate for Payer: Cash Price |
$14,796.42
|
| Rate for Payer: Cash Price |
$14,796.42
|
| Rate for Payer: Cigna Commercial |
$24,562.07
|
| Rate for Payer: First Health Commercial |
$28,113.21
|
| Rate for Payer: Humana Commercial |
$25,153.92
|
| Rate for Payer: Humana KY Medicaid |
$10,176.98
|
| Rate for Payer: Humana Medicare Advantage |
$153.96
|
| Rate for Payer: Kentucky WC Medicaid |
$10,280.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,266.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,839.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,381.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,041.71
|
| Rate for Payer: Ohio Health Group HMO |
$22,194.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,918.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,847.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,173.78
|
| Rate for Payer: PHCS Commercial |
$28,409.14
|
| Rate for Payer: United Healthcare All Payer |
$26,041.71
|
|
|
STELAZINE 2MG TAB
|
Facility
|
OP
|
$9.67
|
|
|
Service Code
|
NDC 51079057320
|
| Hospital Charge Code |
25001432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Anthem Medicaid |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.54
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna Commercial |
$8.03
|
| Rate for Payer: First Health Commercial |
$9.19
|
| Rate for Payer: Humana Commercial |
$8.22
|
| Rate for Payer: Humana KY Medicaid |
$3.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.51
|
| Rate for Payer: Ohio Health Group HMO |
$7.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$9.28
|
| Rate for Payer: United Healthcare All Payer |
$8.51
|
|
|
STELAZINE 2MG TAB
|
Facility
|
IP
|
$9.67
|
|
|
Service Code
|
NDC 51079057320
|
| Hospital Charge Code |
25001432
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.54
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna Commercial |
$8.03
|
| Rate for Payer: First Health Commercial |
$9.19
|
| Rate for Payer: Humana Commercial |
$8.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.51
|
| Rate for Payer: Ohio Health Group HMO |
$7.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$9.28
|
| Rate for Payer: United Healthcare All Payer |
$8.51
|
|
|
STELAZINE 5MG TABLET
|
Facility
|
OP
|
$9.14
|
|
|
Service Code
|
NDC 378240501
|
| Hospital Charge Code |
25001433
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.77 |
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Anthem Medicaid |
$3.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.13
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: Cigna Commercial |
$7.59
|
| Rate for Payer: First Health Commercial |
$8.68
|
| Rate for Payer: Humana Commercial |
$7.77
|
| Rate for Payer: Humana KY Medicaid |
$3.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.83
|
| Rate for Payer: PHCS Commercial |
$8.77
|
| Rate for Payer: United Healthcare All Payer |
$8.04
|
|
|
STELAZINE 5MG TABLET
|
Facility
|
IP
|
$9.14
|
|
|
Service Code
|
NDC 378240501
|
| Hospital Charge Code |
25001433
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.77 |
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.13
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: Cigna Commercial |
$7.59
|
| Rate for Payer: First Health Commercial |
$8.68
|
| Rate for Payer: Humana Commercial |
$7.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.83
|
| Rate for Payer: PHCS Commercial |
$8.77
|
| Rate for Payer: United Healthcare All Payer |
$8.04
|
|
|
STEM 15*200 34MM CALCAR
|
Facility
|
OP
|
$29,003.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,770.41 |
| Max. Negotiated Rate |
$27,843.02 |
| Rate for Payer: Aetna Commercial |
$22,332.43
|
| Rate for Payer: Anthem Medicaid |
$9,974.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,622.46
|
| Rate for Payer: Cash Price |
$14,501.58
|
| Rate for Payer: Cigna Commercial |
$24,072.61
|
| Rate for Payer: First Health Commercial |
$27,552.99
|
| Rate for Payer: Humana Commercial |
$24,652.68
|
| Rate for Payer: Humana KY Medicaid |
$9,974.18
|
| Rate for Payer: Kentucky WC Medicaid |
$10,075.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,782.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,404.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,700.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,174.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,522.77
|
| Rate for Payer: Ohio Health Group HMO |
$21,752.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,800.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,770.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,990.98
|
| Rate for Payer: PHCS Commercial |
$27,843.02
|
| Rate for Payer: United Healthcare All Payer |
$25,522.77
|
|
|
STEM 15*200 34MM CALCAR
|
Facility
|
IP
|
$29,003.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,770.41 |
| Max. Negotiated Rate |
$27,843.02 |
| Rate for Payer: Aetna Commercial |
$22,332.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,622.46
|
| Rate for Payer: Cash Price |
$14,501.58
|
| Rate for Payer: Cigna Commercial |
$24,072.61
|
| Rate for Payer: First Health Commercial |
$27,552.99
|
| Rate for Payer: Humana Commercial |
$24,652.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,782.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,404.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,700.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,522.77
|
| Rate for Payer: Ohio Health Group HMO |
$21,752.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,800.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,770.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,990.98
|
| Rate for Payer: PHCS Commercial |
$27,843.02
|
| Rate for Payer: United Healthcare All Payer |
$25,522.77
|
|
|
STEM 46MM SPS0021
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM 46MM SPS0021
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM ACCOLADE II SZ 0 127 DEG
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 0 127 DEG
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM ACCOLADE II SZ 0 132 DEG
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
