|
ACETASOL(ACTICACIDHC)2%SOL10ML
|
Facility
|
OP
|
$2.77
|
|
|
Service Code
|
NDC 51672300701
|
| Hospital Charge Code |
25000142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.13
|
| Rate for Payer: Anthem Medicaid |
$0.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.16
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cigna Commercial |
$2.30
|
| Rate for Payer: First Health Commercial |
$2.63
|
| Rate for Payer: Humana Commercial |
$2.35
|
| Rate for Payer: Humana KY Medicaid |
$0.95
|
| Rate for Payer: Kentucky WC Medicaid |
$0.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.44
|
| Rate for Payer: Ohio Health Group HMO |
$2.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.91
|
| Rate for Payer: PHCS Commercial |
$2.66
|
| Rate for Payer: United Healthcare All Payer |
$2.44
|
|
|
ACETIC ACID 0.25% 250mL BOTTLE
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
NDC 990614322
|
| Hospital Charge Code |
25004001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.67 |
| 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 |
$18.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.67
|
| 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 |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.35
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
ACETIC ACID 0.25% 250mL BOTTLE
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
NDC 990614322
|
| Hospital Charge Code |
25004001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.67 |
| 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 |
$18.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.67
|
| 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 |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.35
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
ACETIC ACID 0.25% AQUEOUS 8 OZ
|
Facility
|
IP
|
$787.50
|
|
| Hospital Charge Code |
25002798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.38
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
|
ACETIC ACID 0.25% AQUEOUS 8 OZ
|
Facility
|
OP
|
$787.50
|
|
| Hospital Charge Code |
25002798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem Medicaid |
$270.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| Rate for Payer: Humana KY Medicaid |
$270.82
|
| Rate for Payer: Kentucky WC Medicaid |
$273.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.38
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
|
ACETIC ACID 0.5% 100CC
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
25002795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
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 |
$0.89 |
| Max. Negotiated Rate |
$2.86 |
| 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
|
| 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 |
$2.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.06
|
| Rate for Payer: PHCS Commercial |
$2.86
|
| Rate for Payer: United Healthcare All Payer |
$2.62
|
|
|
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 |
$0.89 |
| 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 |
$2.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.06
|
| Rate for Payer: PHCS Commercial |
$2.86
|
| Rate for Payer: United Healthcare All Payer |
$2.62
|
|
|
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 |
$6.67 |
| 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 |
$18.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.67
|
| 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 |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.35
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
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 |
$6.67 |
| 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 |
$18.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.67
|
| 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 |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.35
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
ACET LNR 22*44-45 0 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*44-45 0 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*44-45 20 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*44-45 20 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*46-48 0 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*46-48 0 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*46-48 20 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*46-48 20 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*50-54 0 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*50-54 0 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*50-54 20 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*50-54 20 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*56-62 0 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*56-62 0 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
