|
SYMBICORT 80/4.5mcg120PUFF INH
|
Facility
|
IP
|
$5.19
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.98 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.05
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cigna Commercial |
$4.31
|
| Rate for Payer: First Health Commercial |
$4.93
|
| Rate for Payer: Humana Commercial |
$4.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.57
|
| Rate for Payer: Ohio Health Group HMO |
$3.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.61
|
| Rate for Payer: PHCS Commercial |
$4.98
|
| Rate for Payer: United Healthcare All Payer |
$4.57
|
|
|
SYMBICORT 80/4.5mcg120PUFF INH
|
Facility
|
OP
|
$5.19
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$4.98 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Anthem Medicaid |
$1.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.05
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cigna Commercial |
$4.31
|
| Rate for Payer: First Health Commercial |
$4.93
|
| Rate for Payer: Humana Commercial |
$4.41
|
| Rate for Payer: Humana KY Medicaid |
$1.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.57
|
| Rate for Payer: Ohio Health Group HMO |
$3.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.61
|
| Rate for Payer: PHCS Commercial |
$4.98
|
| Rate for Payer: United Healthcare All Payer |
$4.57
|
|
|
SYMBICORT 80 4.5MCG INHALER
|
Facility
|
IP
|
$9.27
|
|
|
Service Code
|
NDC 186037228
|
| Hospital Charge Code |
25001465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$8.90 |
| Rate for Payer: Aetna Commercial |
$7.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.23
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cigna Commercial |
$7.69
|
| Rate for Payer: First Health Commercial |
$8.81
|
| Rate for Payer: Humana Commercial |
$7.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.16
|
| Rate for Payer: Ohio Health Group HMO |
$6.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.87
|
| Rate for Payer: PHCS Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Payer |
$8.16
|
|
|
SYMBICORT 80 4.5MCG INHALER
|
Facility
|
OP
|
$9.27
|
|
|
Service Code
|
NDC 186037228
|
| Hospital Charge Code |
25001465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$8.90 |
| Rate for Payer: Aetna Commercial |
$7.14
|
| Rate for Payer: Anthem Medicaid |
$3.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.23
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cigna Commercial |
$7.69
|
| Rate for Payer: First Health Commercial |
$8.81
|
| Rate for Payer: Humana Commercial |
$7.88
|
| Rate for Payer: Humana KY Medicaid |
$3.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.16
|
| Rate for Payer: Ohio Health Group HMO |
$6.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.87
|
| Rate for Payer: PHCS Commercial |
$8.90
|
| Rate for Payer: United Healthcare All Payer |
$8.16
|
|
|
SYMMETREL (AMANTADI 100MG/1CAP
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 50268006915
|
| Hospital Charge Code |
25001468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.80
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.30
|
| Rate for Payer: First Health Commercial |
$9.50
|
| Rate for Payer: Humana Commercial |
$8.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.80
|
| Rate for Payer: Ohio Health Group HMO |
$7.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Payer |
$8.80
|
|
|
SYMMETREL (AMANTADI 100MG/1CAP
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
NDC 50268006915
|
| Hospital Charge Code |
25001468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Anthem Medicaid |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.80
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.30
|
| Rate for Payer: First Health Commercial |
$9.50
|
| Rate for Payer: Humana Commercial |
$8.50
|
| Rate for Payer: Humana KY Medicaid |
$3.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.80
|
| Rate for Payer: Ohio Health Group HMO |
$7.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Payer |
$8.80
|
|
|
SYMMETRY 3*10*135
|
Facility
|
OP
|
$3,446.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.98 |
| Max. Negotiated Rate |
$3,308.16 |
| Rate for Payer: Aetna Commercial |
$2,653.42
|
| Rate for Payer: Anthem Medicaid |
$1,185.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,687.88
|
| Rate for Payer: Cash Price |
$1,723.00
|
| Rate for Payer: Cigna Commercial |
$2,860.18
|
| Rate for Payer: First Health Commercial |
$3,273.70
|
| Rate for Payer: Humana Commercial |
$2,929.10
|
| Rate for Payer: Humana KY Medicaid |
$1,185.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,197.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,825.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,543.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,033.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,208.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,032.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,584.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.26
|
| Rate for Payer: PHCS Commercial |
$3,308.16
|
| Rate for Payer: United Healthcare All Payer |
$3,032.48
|
|
|
SYMMETRY 3*10*135
|
Facility
|
IP
|
$3,446.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.98 |
| Max. Negotiated Rate |
$3,308.16 |
| Rate for Payer: Aetna Commercial |
$2,653.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,687.88
|
| Rate for Payer: Cash Price |
$1,723.00
|
| Rate for Payer: Cigna Commercial |
$2,860.18
|
| Rate for Payer: First Health Commercial |
$3,273.70
|
| Rate for Payer: Humana Commercial |
$2,929.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,825.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,543.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,033.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,032.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,584.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.26
|
| Rate for Payer: PHCS Commercial |
$3,308.16
|
| Rate for Payer: United Healthcare All Payer |
$3,032.48
|
|
|
SYMMETRY 3*2*135
|
Facility
|
IP
|
$3,446.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.98 |
| Max. Negotiated Rate |
$3,308.16 |
| Rate for Payer: Aetna Commercial |
$2,653.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,687.88
|
| Rate for Payer: Cash Price |
$1,723.00
|
| Rate for Payer: Cigna Commercial |
$2,860.18
|
| Rate for Payer: First Health Commercial |
$3,273.70
|
| Rate for Payer: Humana Commercial |
$2,929.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,825.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,543.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,033.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,032.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,584.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.26
|
| Rate for Payer: PHCS Commercial |
$3,308.16
|
| Rate for Payer: United Healthcare All Payer |
$3,032.48
|
|
|
SYMMETRY 3*2*135
|
Facility
|
OP
|
$3,446.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.98 |
| Max. Negotiated Rate |
$3,308.16 |
| Rate for Payer: Aetna Commercial |
$2,653.42
|
| Rate for Payer: Anthem Medicaid |
$1,185.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,687.88
|
| Rate for Payer: Cash Price |
$1,723.00
|
| Rate for Payer: Cigna Commercial |
$2,860.18
|
| Rate for Payer: First Health Commercial |
$3,273.70
|
| Rate for Payer: Humana Commercial |
$2,929.10
|
| Rate for Payer: Humana KY Medicaid |
$1,185.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,197.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,825.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,543.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,033.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,208.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,032.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,584.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.26
|
| Rate for Payer: PHCS Commercial |
$3,308.16
|
| Rate for Payer: United Healthcare All Payer |
$3,032.48
|
|
|
SYMMETRY 3*4*135
|
Facility
|
IP
|
$3,446.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.98 |
| Max. Negotiated Rate |
$3,308.16 |
| Rate for Payer: Aetna Commercial |
$2,653.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,687.88
|
| Rate for Payer: Cash Price |
$1,723.00
|
| Rate for Payer: Cigna Commercial |
$2,860.18
|
| Rate for Payer: First Health Commercial |
$3,273.70
|
| Rate for Payer: Humana Commercial |
$2,929.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,825.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,543.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,033.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,032.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,584.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.26
|
| Rate for Payer: PHCS Commercial |
$3,308.16
|
| Rate for Payer: United Healthcare All Payer |
$3,032.48
|
|
|
SYMMETRY 3*4*135
|
Facility
|
OP
|
$3,446.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.98 |
| Max. Negotiated Rate |
$3,308.16 |
| Rate for Payer: Aetna Commercial |
$2,653.42
|
| Rate for Payer: Anthem Medicaid |
$1,185.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,687.88
|
| Rate for Payer: Cash Price |
$1,723.00
|
| Rate for Payer: Cigna Commercial |
$2,860.18
|
| Rate for Payer: First Health Commercial |
$3,273.70
|
| Rate for Payer: Humana Commercial |
$2,929.10
|
| Rate for Payer: Humana KY Medicaid |
$1,185.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,197.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,825.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,543.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,033.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,208.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,032.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,584.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.26
|
| Rate for Payer: PHCS Commercial |
$3,308.16
|
| Rate for Payer: United Healthcare All Payer |
$3,032.48
|
|
|
SYNAGIS 50MG 0.5ML VIAL
|
Facility
|
OP
|
$3,570.66
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$339.68 |
| Max. Negotiated Rate |
$3,427.83 |
| Rate for Payer: Aetna Commercial |
$2,749.41
|
| Rate for Payer: Anthem Medicaid |
$1,227.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$339.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,785.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$475.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$458.57
|
| Rate for Payer: Cash Price |
$1,785.33
|
| Rate for Payer: Cash Price |
$1,785.33
|
| Rate for Payer: Cigna Commercial |
$2,963.65
|
| Rate for Payer: First Health Commercial |
$3,392.13
|
| Rate for Payer: Humana Commercial |
$3,035.06
|
| Rate for Payer: Humana KY Medicaid |
$1,227.95
|
| Rate for Payer: Humana Medicare Advantage |
$339.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,240.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,927.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,635.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$407.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,252.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,142.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,678.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,106.90
|
| Rate for Payer: PHCS Commercial |
$3,427.83
|
| Rate for Payer: United Healthcare All Payer |
$3,142.18
|
|
|
SYNAGIS 50MG 0.5ML VIAL
|
Facility
|
IP
|
$3,570.66
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$464.19 |
| Max. Negotiated Rate |
$3,427.83 |
| Rate for Payer: Aetna Commercial |
$2,749.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,785.11
|
| Rate for Payer: Cash Price |
$1,785.33
|
| Rate for Payer: Cigna Commercial |
$2,963.65
|
| Rate for Payer: First Health Commercial |
$3,392.13
|
| Rate for Payer: Humana Commercial |
$3,035.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,927.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,635.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,142.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,678.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,106.90
|
| Rate for Payer: PHCS Commercial |
$3,427.83
|
| Rate for Payer: United Healthcare All Payer |
$3,142.18
|
|
|
SYNALAR(FLUOCINOLONG).024 15GM
|
Facility
|
IP
|
$11.95
|
|
|
Service Code
|
NDC 713022415
|
| Hospital Charge Code |
25003507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Aetna Commercial |
$9.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.32
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cigna Commercial |
$9.92
|
| Rate for Payer: First Health Commercial |
$11.35
|
| Rate for Payer: Humana Commercial |
$10.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.52
|
| Rate for Payer: Ohio Health Group HMO |
$8.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.70
|
| Rate for Payer: PHCS Commercial |
$11.47
|
| Rate for Payer: United Healthcare All Payer |
$10.52
|
|
|
SYNALAR(FLUOCINOLONG).024 15GM
|
Facility
|
OP
|
$11.95
|
|
|
Service Code
|
NDC 713022415
|
| Hospital Charge Code |
25003507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Aetna Commercial |
$9.20
|
| Rate for Payer: Anthem Medicaid |
$4.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.32
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cigna Commercial |
$9.92
|
| Rate for Payer: First Health Commercial |
$11.35
|
| Rate for Payer: Humana Commercial |
$10.16
|
| Rate for Payer: Humana KY Medicaid |
$4.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.52
|
| Rate for Payer: Ohio Health Group HMO |
$8.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.70
|
| Rate for Payer: PHCS Commercial |
$11.47
|
| Rate for Payer: United Healthcare All Payer |
$10.52
|
|
|
SYNATOMIC VARIBLE FIT TIB CLIP
|
Facility
|
OP
|
$3,988.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.50 |
| Max. Negotiated Rate |
$3,828.96 |
| Rate for Payer: Aetna Commercial |
$3,071.14
|
| Rate for Payer: Anthem Medicaid |
$1,371.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,111.03
|
| Rate for Payer: Cash Price |
$1,994.25
|
| Rate for Payer: Cigna Commercial |
$3,310.46
|
| Rate for Payer: First Health Commercial |
$3,789.08
|
| Rate for Payer: Humana Commercial |
$3,390.22
|
| Rate for Payer: Humana KY Medicaid |
$1,371.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,385.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,270.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,943.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,399.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,509.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,991.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,236.44
|
| Rate for Payer: PHCS Commercial |
$3,828.96
|
| Rate for Payer: United Healthcare All Payer |
$3,509.88
|
|
|
SYNATOMIC VARIBLE FIT TIB CLIP
|
Facility
|
IP
|
$3,988.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.50 |
| Max. Negotiated Rate |
$3,828.96 |
| Rate for Payer: Aetna Commercial |
$3,071.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,111.03
|
| Rate for Payer: Cash Price |
$1,994.25
|
| Rate for Payer: Cigna Commercial |
$3,310.46
|
| Rate for Payer: First Health Commercial |
$3,789.08
|
| Rate for Payer: Humana Commercial |
$3,390.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,270.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,943.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,509.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,991.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,236.44
|
| Rate for Payer: PHCS Commercial |
$3,828.96
|
| Rate for Payer: United Healthcare All Payer |
$3,509.88
|
|
|
SYN CEM FEM COMP SZ 10
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
SYN CEM FEM COMP SZ 10
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
SYN CEM FEM COMP SZ 11
|
Facility
|
OP
|
$8,356.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,086.30 |
| Max. Negotiated Rate |
$8,021.89 |
| Rate for Payer: Aetna Commercial |
$6,434.23
|
| Rate for Payer: Anthem Medicaid |
$2,873.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,517.79
|
| Rate for Payer: Cash Price |
$4,178.07
|
| Rate for Payer: Cigna Commercial |
$6,935.60
|
| Rate for Payer: First Health Commercial |
$7,938.33
|
| Rate for Payer: Humana Commercial |
$7,102.72
|
| Rate for Payer: Humana KY Medicaid |
$2,873.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,852.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,166.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,931.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,353.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,267.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,590.40
|
| Rate for Payer: PHCS Commercial |
$8,021.89
|
| Rate for Payer: United Healthcare All Payer |
$7,353.40
|
|
|
SYN CEM FEM COMP SZ 11
|
Facility
|
IP
|
$8,356.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,086.30 |
| Max. Negotiated Rate |
$8,021.89 |
| Rate for Payer: Aetna Commercial |
$6,434.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,517.79
|
| Rate for Payer: Cash Price |
$4,178.07
|
| Rate for Payer: Cigna Commercial |
$6,935.60
|
| Rate for Payer: First Health Commercial |
$7,938.33
|
| Rate for Payer: Humana Commercial |
$7,102.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,852.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,166.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,353.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,267.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,590.40
|
| Rate for Payer: PHCS Commercial |
$8,021.89
|
| Rate for Payer: United Healthcare All Payer |
$7,353.40
|
|
|
SYN CEM FEM COMP SZ 12
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
SYN CEM FEM COMP SZ 12
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
SYN CEM FEM COMP SZ 13
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
