|
ACETIC ACID 0.25% AQUEOUS 8 OZ
|
Facility
|
OP
|
$768.75
|
|
| Hospital Charge Code |
25002798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.94 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$591.94
|
| Rate for Payer: Anthem Medicaid |
$264.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.62
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Cigna Commercial |
$638.06
|
| Rate for Payer: First Health Commercial |
$730.31
|
| Rate for Payer: Humana Commercial |
$653.44
|
| Rate for Payer: Humana KY Medicaid |
$264.37
|
| Rate for Payer: Kentucky WC Medicaid |
$267.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$630.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$567.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$676.50
|
| Rate for Payer: Ohio Health Group HMO |
$576.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.31
|
| Rate for Payer: PHCS Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Payer |
$676.50
|
|
|
ACETIC ACID 0.5% 100CC
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
25002795
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
ACETIC ACID 0.5% 100CC
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
25002795
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
ACETIC ACID 2% OTIC 15ML SOLN
|
Facility
|
IP
|
$2.98
|
|
|
Service Code
|
NDC 52817081615
|
| Hospital Charge Code |
25002796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.32
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna Commercial |
$2.47
|
| Rate for Payer: First Health Commercial |
$2.83
|
| Rate for Payer: Humana Commercial |
$2.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.62
|
| Rate for Payer: Ohio Health Group HMO |
$2.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.92
|
| Rate for Payer: PHCS Commercial |
$2.86
|
| Rate for Payer: United Healthcare All Payer |
$2.62
|
|
|
ACETIC ACID 2% OTIC 15ML SOLN
|
Facility
|
OP
|
$2.98
|
|
|
Service Code
|
NDC 52817081615
|
| Hospital Charge Code |
25002796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Humana Commercial |
$2.53
|
| Rate for Payer: Humana KY Medicaid |
$1.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.62
|
| Rate for Payer: Ohio Health Group HMO |
$2.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.92
|
| Rate for Payer: PHCS Commercial |
$2.86
|
| Rate for Payer: United Healthcare All Payer |
$2.62
|
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Anthem Medicaid |
$1.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.32
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cigna Commercial |
$2.47
|
| Rate for Payer: First Health Commercial |
$2.83
|
|
|
ACETIC ACID IRRIG 0.25%/1000ML
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
NDC 990614309
|
| Hospital Charge Code |
25002798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.36
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: First Health Commercial |
$21.14
|
| Rate for Payer: Humana Commercial |
$18.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.58
|
| Rate for Payer: Ohio Health Group HMO |
$16.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
ACETIC ACID IRRIG 0.25%/1000ML
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
NDC 990614309
|
| Hospital Charge Code |
25002798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Anthem Medicaid |
$7.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.36
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: First Health Commercial |
$21.14
|
| Rate for Payer: Humana Commercial |
$18.91
|
| Rate for Payer: Humana KY Medicaid |
$7.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.58
|
| Rate for Payer: Ohio Health Group HMO |
$16.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
ACET LNR 22*44-45 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*44-45 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
|
|
ACET LNR 22*44-45 20 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*44-45 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*46-48 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*46-48 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*46-48 20 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*46-48 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*50-54 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*50-54 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*50-54 20 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*50-54 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*56-62 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*56-62 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*56-62 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*56-62 20 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*63-70 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*63-70 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
