|
TRIGLYCERIDE BLOOD
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
30000539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$5.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.74
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$5.74
|
| Rate for Payer: Humana Medicare Advantage |
$5.74
|
| Rate for Payer: Kentucky WC Medicaid |
$5.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
TRIGLYCERIDE BLOOD
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
30000539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
TRILAFON (PERPHENAZIN 2MG/1TAB
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
NDC 591410101
|
| Hospital Charge Code |
25001596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: First Health Commercial |
$4.42
|
| Rate for Payer: Humana Commercial |
$3.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.09
|
| Rate for Payer: Ohio Health Group HMO |
$3.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.21
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
|
TRILAFON (PERPHENAZIN 2MG/1TAB
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
NDC 591410101
|
| Hospital Charge Code |
25001596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: First Health Commercial |
$4.42
|
| Rate for Payer: Humana Commercial |
$3.95
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.09
|
| Rate for Payer: Ohio Health Group HMO |
$3.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.21
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
|
TRILAFON (PERPHENAZIN 4MG/1TAB
|
Facility
|
IP
|
$4.57
|
|
|
Service Code
|
NDC 64980029101
|
| Hospital Charge Code |
25001597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
TRILAFON (PERPHENAZIN 4MG/1TAB
|
Facility
|
OP
|
$4.57
|
|
|
Service Code
|
NDC 64980029101
|
| Hospital Charge Code |
25001597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem Medicaid |
$1.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Humana KY Medicaid |
$1.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
TRILEPTAL 300 MG 5ML ORAL SUSP
|
Facility
|
OP
|
$24.27
|
|
|
Service Code
|
NDC 68094012362
|
| Hospital Charge Code |
25001598
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.30 |
| Rate for Payer: Aetna Commercial |
$18.69
|
| Rate for Payer: Anthem Medicaid |
$8.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.93
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: Cigna Commercial |
$20.14
|
| Rate for Payer: First Health Commercial |
$23.06
|
| Rate for Payer: Humana Commercial |
$20.63
|
| Rate for Payer: Humana KY Medicaid |
$8.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.36
|
| Rate for Payer: Ohio Health Group HMO |
$18.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.75
|
| Rate for Payer: PHCS Commercial |
$23.30
|
| Rate for Payer: United Healthcare All Payer |
$21.36
|
|
|
TRILEPTAL 300 MG 5ML ORAL SUSP
|
Facility
|
IP
|
$24.27
|
|
|
Service Code
|
NDC 68094012362
|
| Hospital Charge Code |
25001598
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.30 |
| Rate for Payer: Aetna Commercial |
$18.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.93
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: Cigna Commercial |
$20.14
|
| Rate for Payer: First Health Commercial |
$23.06
|
| Rate for Payer: Humana Commercial |
$20.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.36
|
| Rate for Payer: Ohio Health Group HMO |
$18.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.75
|
| Rate for Payer: PHCS Commercial |
$23.30
|
| Rate for Payer: United Healthcare All Payer |
$21.36
|
|
|
TRILEPTAL(OXCARBAZEPINE)150MGT
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 68462013701
|
| Hospital Charge Code |
25001600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
TRILEPTAL(OXCARBAZEPINE)150MGT
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 68462013701
|
| Hospital Charge Code |
25001600
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
TRI LM/RL TIB AUG SZ 1 10MM
|
Facility
|
OP
|
$7,737.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,321.31 |
| Max. Negotiated Rate |
$7,428.19 |
| Rate for Payer: Aetna Commercial |
$5,958.03
|
| Rate for Payer: Anthem Medicaid |
$2,661.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,035.41
|
| Rate for Payer: Cash Price |
$3,868.85
|
| Rate for Payer: Cigna Commercial |
$6,422.29
|
| Rate for Payer: First Health Commercial |
$7,350.81
|
| Rate for Payer: Humana Commercial |
$6,577.05
|
| Rate for Payer: Humana KY Medicaid |
$2,661.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,688.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,344.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,710.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,321.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,714.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,809.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,803.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,190.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,731.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,339.01
|
| Rate for Payer: PHCS Commercial |
$7,428.19
|
| Rate for Payer: United Healthcare All Payer |
$6,809.18
|
|
|
TRI LM/RL TIB AUG SZ 1 10MM
|
Facility
|
IP
|
$7,737.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,321.31 |
| Max. Negotiated Rate |
$7,428.19 |
| Rate for Payer: Aetna Commercial |
$5,958.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,035.41
|
| Rate for Payer: Cash Price |
$3,868.85
|
| Rate for Payer: Cigna Commercial |
$6,422.29
|
| Rate for Payer: First Health Commercial |
$7,350.81
|
| Rate for Payer: Humana Commercial |
$6,577.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,344.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,710.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,321.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,809.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,803.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,190.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,731.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,339.01
|
| Rate for Payer: PHCS Commercial |
$7,428.19
|
| Rate for Payer: United Healthcare All Payer |
$6,809.18
|
|
|
TRI LM/RL TIB AUG SZ 1 5MM
|
Facility
|
OP
|
$7,084.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.35 |
| Max. Negotiated Rate |
$6,801.12 |
| Rate for Payer: Aetna Commercial |
$5,455.06
|
| Rate for Payer: Anthem Medicaid |
$2,436.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,525.91
|
| Rate for Payer: Cash Price |
$3,542.25
|
| Rate for Payer: Cigna Commercial |
$5,880.14
|
| Rate for Payer: First Health Commercial |
$6,730.27
|
| Rate for Payer: Humana Commercial |
$6,021.82
|
| Rate for Payer: Humana KY Medicaid |
$2,436.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,809.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,228.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,234.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,313.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,667.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,163.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,888.31
|
| Rate for Payer: PHCS Commercial |
$6,801.12
|
| Rate for Payer: United Healthcare All Payer |
$6,234.36
|
|
|
TRI LM/RL TIB AUG SZ 1 5MM
|
Facility
|
IP
|
$7,084.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.35 |
| Max. Negotiated Rate |
$6,801.12 |
| Rate for Payer: Aetna Commercial |
$5,455.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,525.91
|
| Rate for Payer: Cash Price |
$3,542.25
|
| Rate for Payer: Cigna Commercial |
$5,880.14
|
| Rate for Payer: First Health Commercial |
$6,730.27
|
| Rate for Payer: Humana Commercial |
$6,021.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,809.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,228.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,234.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,313.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,667.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,163.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,888.31
|
| Rate for Payer: PHCS Commercial |
$6,801.12
|
| Rate for Payer: United Healthcare All Payer |
$6,234.36
|
|
|
TRI LM/RL TIB AUG SZ 2 10MM
|
Facility
|
IP
|
$7,422.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.81 |
| Max. Negotiated Rate |
$7,125.79 |
| Rate for Payer: Aetna Commercial |
$5,715.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,789.71
|
| Rate for Payer: Cash Price |
$3,711.35
|
| Rate for Payer: Cigna Commercial |
$6,160.84
|
| Rate for Payer: First Health Commercial |
$7,051.56
|
| Rate for Payer: Humana Commercial |
$6,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,086.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,477.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,531.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,567.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,938.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,457.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,121.66
|
| Rate for Payer: PHCS Commercial |
$7,125.79
|
| Rate for Payer: United Healthcare All Payer |
$6,531.98
|
|
|
TRI LM/RL TIB AUG SZ 2 10MM
|
Facility
|
OP
|
$7,422.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.81 |
| Max. Negotiated Rate |
$7,125.79 |
| Rate for Payer: Aetna Commercial |
$5,715.48
|
| Rate for Payer: Anthem Medicaid |
$2,552.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,789.71
|
| Rate for Payer: Cash Price |
$3,711.35
|
| Rate for Payer: Cigna Commercial |
$6,160.84
|
| Rate for Payer: First Health Commercial |
$7,051.56
|
| Rate for Payer: Humana Commercial |
$6,309.30
|
| Rate for Payer: Humana KY Medicaid |
$2,552.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,578.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,086.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,477.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,603.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,531.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,567.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,938.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,457.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,121.66
|
| Rate for Payer: PHCS Commercial |
$7,125.79
|
| Rate for Payer: United Healthcare All Payer |
$6,531.98
|
|
|
TRI LM/RL TIB AUG SZ 2 5MM
|
Facility
|
IP
|
$8,005.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.57 |
| Max. Negotiated Rate |
$7,685.03 |
| Rate for Payer: Aetna Commercial |
$6,164.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,244.09
|
| Rate for Payer: Cash Price |
$4,002.62
|
| Rate for Payer: Cigna Commercial |
$6,644.35
|
| Rate for Payer: First Health Commercial |
$7,604.98
|
| Rate for Payer: Humana Commercial |
$6,804.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,564.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,907.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,044.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,003.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,404.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,964.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,523.62
|
| Rate for Payer: PHCS Commercial |
$7,685.03
|
| Rate for Payer: United Healthcare All Payer |
$7,044.61
|
|
|
TRI LM/RL TIB AUG SZ 2 5MM
|
Facility
|
OP
|
$8,005.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.57 |
| Max. Negotiated Rate |
$7,685.03 |
| Rate for Payer: Aetna Commercial |
$6,164.03
|
| Rate for Payer: Anthem Medicaid |
$2,753.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,244.09
|
| Rate for Payer: Cash Price |
$4,002.62
|
| Rate for Payer: Cigna Commercial |
$6,644.35
|
| Rate for Payer: First Health Commercial |
$7,604.98
|
| Rate for Payer: Humana Commercial |
$6,804.45
|
| Rate for Payer: Humana KY Medicaid |
$2,753.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,781.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,564.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,907.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,808.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,044.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,003.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,404.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,964.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,523.62
|
| Rate for Payer: PHCS Commercial |
$7,685.03
|
| Rate for Payer: United Healthcare All Payer |
$7,044.61
|
|
|
TRI LM/RL TIB AUG SZ 3 10MM
|
Facility
|
IP
|
$7,251.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.46 |
| Max. Negotiated Rate |
$6,961.46 |
| Rate for Payer: Aetna Commercial |
$5,583.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,656.19
|
| Rate for Payer: Cash Price |
$3,625.76
|
| Rate for Payer: Cigna Commercial |
$6,018.76
|
| Rate for Payer: First Health Commercial |
$6,888.94
|
| Rate for Payer: Humana Commercial |
$6,163.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,381.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$6,961.46
|
| Rate for Payer: United Healthcare All Payer |
$6,381.34
|
|
|
TRI LM/RL TIB AUG SZ 3 10MM
|
Facility
|
OP
|
$7,251.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.46 |
| Max. Negotiated Rate |
$6,961.46 |
| Rate for Payer: Aetna Commercial |
$5,583.67
|
| Rate for Payer: Anthem Medicaid |
$2,493.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,656.19
|
| Rate for Payer: Cash Price |
$3,625.76
|
| Rate for Payer: Cigna Commercial |
$6,018.76
|
| Rate for Payer: First Health Commercial |
$6,888.94
|
| Rate for Payer: Humana Commercial |
$6,163.79
|
| Rate for Payer: Humana KY Medicaid |
$2,493.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,519.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,543.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,381.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$6,961.46
|
| Rate for Payer: United Healthcare All Payer |
$6,381.34
|
|
|
TRI LM/RL TIB AUG SZ 3 5MM
|
Facility
|
IP
|
$8,005.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.57 |
| Max. Negotiated Rate |
$7,685.03 |
| Rate for Payer: Aetna Commercial |
$6,164.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,244.09
|
| Rate for Payer: Cash Price |
$4,002.62
|
| Rate for Payer: Cigna Commercial |
$6,644.35
|
| Rate for Payer: First Health Commercial |
$7,604.98
|
| Rate for Payer: Humana Commercial |
$6,804.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,564.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,907.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,044.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,003.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,404.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,964.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,523.62
|
| Rate for Payer: PHCS Commercial |
$7,685.03
|
| Rate for Payer: United Healthcare All Payer |
$7,044.61
|
|
|
TRI LM/RL TIB AUG SZ 3 5MM
|
Facility
|
OP
|
$8,005.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.57 |
| Max. Negotiated Rate |
$7,685.03 |
| Rate for Payer: Aetna Commercial |
$6,164.03
|
| Rate for Payer: Anthem Medicaid |
$2,753.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,244.09
|
| Rate for Payer: Cash Price |
$4,002.62
|
| Rate for Payer: Cigna Commercial |
$6,644.35
|
| Rate for Payer: First Health Commercial |
$7,604.98
|
| Rate for Payer: Humana Commercial |
$6,804.45
|
| Rate for Payer: Humana KY Medicaid |
$2,753.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,781.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,564.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,907.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,808.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,044.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,003.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,404.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,964.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,523.62
|
| Rate for Payer: PHCS Commercial |
$7,685.03
|
| Rate for Payer: United Healthcare All Payer |
$7,044.61
|
|
|
TRI LM/RL TIB AUG SZ 4 10MM
|
Facility
|
OP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem Medicaid |
$2,623.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Humana KY Medicaid |
$2,623.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,650.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI LM/RL TIB AUG SZ 4 10MM
|
Facility
|
IP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI LM/RL TIB AUG SZ 4 5MM
|
Facility
|
OP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem Medicaid |
$2,623.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Humana KY Medicaid |
$2,623.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,650.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
