|
CENTRUM (MULTI VIT/MIN) T 1TAB
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 904264172
|
| Hospital Charge Code |
25000405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.03
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.03
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Payer |
$0.03
|
|
|
CENTRUM(MULTIVIT W/FE)15ML LIQ
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 5434462
|
| Hospital Charge Code |
25000406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Anthem Medicaid |
$1.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.38
|
| Rate for Payer: Humana Commercial |
$3.92
|
| Rate for Payer: Humana KY Medicaid |
$1.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.06
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Payer |
$4.06
|
|
|
CENTRUM(MULTIVIT W/FE)15ML LIQ
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 5434462
|
| Hospital Charge Code |
25000406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.38
|
| Rate for Payer: Humana Commercial |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.06
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Payer |
$4.06
|
|
|
CEPHULAC (LACTULOSE) SYRU 30ML
|
Facility
|
OP
|
$9.97
|
|
|
Service Code
|
NDC 121115440
|
| Hospital Charge Code |
25000408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$7.68
|
| Rate for Payer: Anthem Medicaid |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.78
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: First Health Commercial |
$9.47
|
| Rate for Payer: Humana Commercial |
$8.47
|
| Rate for Payer: Humana KY Medicaid |
$3.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.77
|
| Rate for Payer: Ohio Health Group HMO |
$7.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.88
|
| Rate for Payer: PHCS Commercial |
$9.57
|
| Rate for Payer: United Healthcare All Payer |
$8.77
|
|
|
CEPHULAC (LACTULOSE) SYRU 30ML
|
Facility
|
IP
|
$9.97
|
|
|
Service Code
|
NDC 121115440
|
| Hospital Charge Code |
25000408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$7.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.78
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: First Health Commercial |
$9.47
|
| Rate for Payer: Humana Commercial |
$8.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.77
|
| Rate for Payer: Ohio Health Group HMO |
$7.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.88
|
| Rate for Payer: PHCS Commercial |
$9.57
|
| Rate for Payer: United Healthcare All Payer |
$8.77
|
|
|
CERAMAX INSRT NEU 52MM 36MM ID
|
Facility
|
IP
|
$21,368.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,410.62 |
| Max. Negotiated Rate |
$20,514.00 |
| Rate for Payer: Aetna Commercial |
$16,453.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,667.62
|
| Rate for Payer: Cash Price |
$10,684.38
|
| Rate for Payer: Cigna Commercial |
$17,736.06
|
| Rate for Payer: First Health Commercial |
$20,300.31
|
| Rate for Payer: Humana Commercial |
$18,163.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,522.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,770.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,410.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,804.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,026.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,095.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,590.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,744.44
|
| Rate for Payer: PHCS Commercial |
$20,514.00
|
| Rate for Payer: United Healthcare All Payer |
$18,804.50
|
|
|
CERAMAX INSRT NEU 52MM 36MM ID
|
Facility
|
OP
|
$21,368.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,410.62 |
| Max. Negotiated Rate |
$20,514.00 |
| Rate for Payer: Aetna Commercial |
$16,453.94
|
| Rate for Payer: Anthem Medicaid |
$7,348.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,667.62
|
| Rate for Payer: Cash Price |
$10,684.38
|
| Rate for Payer: Cigna Commercial |
$17,736.06
|
| Rate for Payer: First Health Commercial |
$20,300.31
|
| Rate for Payer: Humana Commercial |
$18,163.44
|
| Rate for Payer: Humana KY Medicaid |
$7,348.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,423.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,522.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,770.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,410.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,496.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,804.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,026.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,095.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,590.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,744.44
|
| Rate for Payer: PHCS Commercial |
$20,514.00
|
| Rate for Payer: United Healthcare All Payer |
$18,804.50
|
|
|
CERAMAX INSRT NEU 54MM 36MM ID
|
Facility
|
IP
|
$21,368.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,410.62 |
| Max. Negotiated Rate |
$20,514.00 |
| Rate for Payer: Aetna Commercial |
$16,453.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,667.62
|
| Rate for Payer: Cash Price |
$10,684.38
|
| Rate for Payer: Cigna Commercial |
$17,736.06
|
| Rate for Payer: First Health Commercial |
$20,300.31
|
| Rate for Payer: Humana Commercial |
$18,163.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,522.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,770.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,410.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,804.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,026.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,095.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,590.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,744.44
|
| Rate for Payer: PHCS Commercial |
$20,514.00
|
| Rate for Payer: United Healthcare All Payer |
$18,804.50
|
|
|
CERAMAX INSRT NEU 54MM 36MM ID
|
Facility
|
OP
|
$21,368.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,410.62 |
| Max. Negotiated Rate |
$20,514.00 |
| Rate for Payer: Aetna Commercial |
$16,453.94
|
| Rate for Payer: Anthem Medicaid |
$7,348.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,667.62
|
| Rate for Payer: Cash Price |
$10,684.38
|
| Rate for Payer: Cigna Commercial |
$17,736.06
|
| Rate for Payer: First Health Commercial |
$20,300.31
|
| Rate for Payer: Humana Commercial |
$18,163.44
|
| Rate for Payer: Humana KY Medicaid |
$7,348.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,423.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,522.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,770.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,410.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,496.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,804.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,026.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,095.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,590.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,744.44
|
| Rate for Payer: PHCS Commercial |
$20,514.00
|
| Rate for Payer: United Healthcare All Payer |
$18,804.50
|
|
|
CERAMAX INSRT NEU 58MM 36MM ID
|
Facility
|
IP
|
$21,368.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,410.62 |
| Max. Negotiated Rate |
$20,514.00 |
| Rate for Payer: Aetna Commercial |
$16,453.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,667.62
|
| Rate for Payer: Cash Price |
$10,684.38
|
| Rate for Payer: Cigna Commercial |
$17,736.06
|
| Rate for Payer: First Health Commercial |
$20,300.31
|
| Rate for Payer: Humana Commercial |
$18,163.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,522.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,770.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,410.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,804.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,026.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,095.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,590.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,744.44
|
| Rate for Payer: PHCS Commercial |
$20,514.00
|
| Rate for Payer: United Healthcare All Payer |
$18,804.50
|
|
|
CERAMAX INSRT NEU 58MM 36MM ID
|
Facility
|
OP
|
$21,368.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,410.62 |
| Max. Negotiated Rate |
$20,514.00 |
| Rate for Payer: Aetna Commercial |
$16,453.94
|
| Rate for Payer: Anthem Medicaid |
$7,348.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,667.62
|
| Rate for Payer: Cash Price |
$10,684.38
|
| Rate for Payer: Cigna Commercial |
$17,736.06
|
| Rate for Payer: First Health Commercial |
$20,300.31
|
| Rate for Payer: Humana Commercial |
$18,163.44
|
| Rate for Payer: Humana KY Medicaid |
$7,348.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,423.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,522.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,770.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,410.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,496.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,804.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,026.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,095.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,590.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,744.44
|
| Rate for Payer: PHCS Commercial |
$20,514.00
|
| Rate for Payer: United Healthcare All Payer |
$18,804.50
|
|
|
CERAMAX INSRT NEU 60MM 36MM ID
|
Facility
|
IP
|
$21,368.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,410.62 |
| Max. Negotiated Rate |
$20,514.00 |
| Rate for Payer: Aetna Commercial |
$16,453.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,667.62
|
| Rate for Payer: Cash Price |
$10,684.38
|
| Rate for Payer: Cigna Commercial |
$17,736.06
|
| Rate for Payer: First Health Commercial |
$20,300.31
|
| Rate for Payer: Humana Commercial |
$18,163.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,522.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,770.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,410.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,804.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,026.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,095.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,590.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,744.44
|
| Rate for Payer: PHCS Commercial |
$20,514.00
|
| Rate for Payer: United Healthcare All Payer |
$18,804.50
|
|
|
CERAMAX INSRT NEU 60MM 36MM ID
|
Facility
|
OP
|
$21,368.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,410.62 |
| Max. Negotiated Rate |
$20,514.00 |
| Rate for Payer: Aetna Commercial |
$16,453.94
|
| Rate for Payer: Anthem Medicaid |
$7,348.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,667.62
|
| Rate for Payer: Cash Price |
$10,684.38
|
| Rate for Payer: Cigna Commercial |
$17,736.06
|
| Rate for Payer: First Health Commercial |
$20,300.31
|
| Rate for Payer: Humana Commercial |
$18,163.44
|
| Rate for Payer: Humana KY Medicaid |
$7,348.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,423.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,522.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,770.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,410.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,496.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,804.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,026.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,095.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,590.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,744.44
|
| Rate for Payer: PHCS Commercial |
$20,514.00
|
| Rate for Payer: United Healthcare All Payer |
$18,804.50
|
|
|
CERAMENT G 10ML
|
Facility
|
IP
|
$32,892.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,867.75 |
| Max. Negotiated Rate |
$31,576.80 |
| Rate for Payer: Aetna Commercial |
$25,327.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,656.15
|
| Rate for Payer: Cash Price |
$16,446.25
|
| Rate for Payer: Cigna Commercial |
$27,300.78
|
| Rate for Payer: First Health Commercial |
$31,247.88
|
| Rate for Payer: Humana Commercial |
$27,958.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,971.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,274.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,867.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,945.40
|
| Rate for Payer: Ohio Health Group HMO |
$24,669.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,616.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,695.83
|
| Rate for Payer: PHCS Commercial |
$31,576.80
|
| Rate for Payer: United Healthcare All Payer |
$28,945.40
|
|
|
CERAMENT G 10ML
|
Facility
|
OP
|
$32,892.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,867.75 |
| Max. Negotiated Rate |
$31,576.80 |
| Rate for Payer: Aetna Commercial |
$25,327.22
|
| Rate for Payer: Anthem Medicaid |
$11,311.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,656.15
|
| Rate for Payer: Cash Price |
$16,446.25
|
| Rate for Payer: Cigna Commercial |
$27,300.78
|
| Rate for Payer: First Health Commercial |
$31,247.88
|
| Rate for Payer: Humana Commercial |
$27,958.62
|
| Rate for Payer: Humana KY Medicaid |
$11,311.73
|
| Rate for Payer: Kentucky WC Medicaid |
$11,426.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,971.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,274.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,867.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,538.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,945.40
|
| Rate for Payer: Ohio Health Group HMO |
$24,669.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,616.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,695.83
|
| Rate for Payer: PHCS Commercial |
$31,576.80
|
| Rate for Payer: United Healthcare All Payer |
$28,945.40
|
|
|
CERAMENT G 5ML
|
Facility
|
OP
|
$20,461.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,138.38 |
| Max. Negotiated Rate |
$19,642.80 |
| Rate for Payer: Aetna Commercial |
$15,755.16
|
| Rate for Payer: Anthem Medicaid |
$7,036.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,959.77
|
| Rate for Payer: Cash Price |
$10,230.62
|
| Rate for Payer: Cigna Commercial |
$16,982.84
|
| Rate for Payer: First Health Commercial |
$19,438.19
|
| Rate for Payer: Humana Commercial |
$17,392.06
|
| Rate for Payer: Humana KY Medicaid |
$7,036.62
|
| Rate for Payer: Kentucky WC Medicaid |
$7,108.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,778.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,100.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,138.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,177.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,005.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,345.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,369.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,801.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,118.26
|
| Rate for Payer: PHCS Commercial |
$19,642.80
|
| Rate for Payer: United Healthcare All Payer |
$18,005.90
|
|
|
CERAMENT G 5ML
|
Facility
|
IP
|
$20,461.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,138.38 |
| Max. Negotiated Rate |
$19,642.80 |
| Rate for Payer: Aetna Commercial |
$15,755.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,959.77
|
| Rate for Payer: Cash Price |
$10,230.62
|
| Rate for Payer: Cigna Commercial |
$16,982.84
|
| Rate for Payer: First Health Commercial |
$19,438.19
|
| Rate for Payer: Humana Commercial |
$17,392.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,778.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,100.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,138.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,005.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,345.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,369.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,801.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,118.26
|
| Rate for Payer: PHCS Commercial |
$19,642.80
|
| Rate for Payer: United Healthcare All Payer |
$18,005.90
|
|
|
CERCLAGE OF CERVIX NONOBSTET
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 57700
|
| Hospital Charge Code |
76102206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
CERCLAGE OF CERVIX NONOBSTET
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 57700
|
| Hospital Charge Code |
76102206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
CERCLAGE OF CERVIX NONOBSTET
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 57700
|
| Hospital Charge Code |
76102206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$453.18
|
| Rate for Payer: Ambetter Exchange |
$331.55
|
| Rate for Payer: Anthem Medicaid |
$169.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$331.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$331.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$397.86
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$431.71
|
| Rate for Payer: Healthspan PPO |
$438.79
|
| Rate for Payer: Humana Medicaid |
$169.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$399.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$331.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.58
|
| Rate for Payer: Molina Healthcare Passport |
$169.20
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$431.01
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$331.55
|
|
|
CERCLAGE OF CERVIX NONOBSTET(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 57700
|
| Hospital Charge Code |
761P2206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$453.18
|
| Rate for Payer: Ambetter Exchange |
$331.55
|
| Rate for Payer: Anthem Medicaid |
$169.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$331.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$331.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$397.86
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$431.71
|
| Rate for Payer: Healthspan PPO |
$438.79
|
| Rate for Payer: Humana Medicaid |
$169.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$399.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$331.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.58
|
| Rate for Payer: Molina Healthcare Passport |
$169.20
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$431.01
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$331.55
|
|
|
CERCLAGE OF CERVIX - PREG -
|
Facility
|
IP
|
$6,709.00
|
|
|
Service Code
|
HCPCS 59320
|
| Hospital Charge Code |
72000014
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,012.70 |
| Max. Negotiated Rate |
$6,440.64 |
| Rate for Payer: Aetna Commercial |
$5,165.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,233.02
|
| Rate for Payer: Cash Price |
$3,354.50
|
| Rate for Payer: Cigna Commercial |
$5,568.47
|
| Rate for Payer: First Health Commercial |
$6,373.55
|
| Rate for Payer: Humana Commercial |
$5,702.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,501.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,951.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,903.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,031.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,367.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,836.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,629.21
|
| Rate for Payer: PHCS Commercial |
$6,440.64
|
| Rate for Payer: United Healthcare All Payer |
$5,903.92
|
|
|
CERCLAGE OF CERVIX - PREG -
|
Professional
|
Both
|
$6,709.00
|
|
|
Service Code
|
HCPCS 59320
|
| Hospital Charge Code |
72000014
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$130.48 |
| Max. Negotiated Rate |
$4,025.40 |
| Rate for Payer: Aetna Commercial |
$255.67
|
| Rate for Payer: Ambetter Exchange |
$145.10
|
| Rate for Payer: Anthem Medicaid |
$130.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$145.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$145.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$174.12
|
| Rate for Payer: Cash Price |
$3,354.50
|
| Rate for Payer: Cash Price |
$3,354.50
|
| Rate for Payer: Cigna Commercial |
$236.17
|
| Rate for Payer: Healthspan PPO |
$185.56
|
| Rate for Payer: Humana Medicaid |
$130.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$145.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.09
|
| Rate for Payer: Molina Healthcare Passport |
$130.48
|
| Rate for Payer: Multiplan PHCS |
$4,025.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$188.63
|
| Rate for Payer: UHCCP Medicaid |
$2,348.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$145.10
|
|
|
CERCLAGE OF CERVIX - PREG -
|
Facility
|
OP
|
$6,709.00
|
|
|
Service Code
|
HCPCS 59320
|
| Hospital Charge Code |
72000014
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,307.23 |
| Max. Negotiated Rate |
$6,440.64 |
| Rate for Payer: Aetna Commercial |
$5,165.93
|
| Rate for Payer: Anthem Medicaid |
$2,307.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,233.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$3,354.50
|
| Rate for Payer: Cash Price |
$3,354.50
|
| Rate for Payer: Cigna Commercial |
$5,568.47
|
| Rate for Payer: First Health Commercial |
$6,373.55
|
| Rate for Payer: Humana Commercial |
$5,702.65
|
| Rate for Payer: Humana KY Medicaid |
$2,307.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,330.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,501.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,951.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,353.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,903.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,031.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,367.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,836.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,629.21
|
| Rate for Payer: PHCS Commercial |
$6,440.64
|
| Rate for Payer: United Healthcare All Payer |
$5,903.92
|
|
|
CERCLAGE OF CERVIX - PREG -(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 59320
|
| Hospital Charge Code |
720P0014
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$130.48 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$255.67
|
| Rate for Payer: Ambetter Exchange |
$145.10
|
| Rate for Payer: Anthem Medicaid |
$130.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$145.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$145.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$174.12
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$236.17
|
| Rate for Payer: Healthspan PPO |
$185.56
|
| Rate for Payer: Humana Medicaid |
$130.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$145.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.09
|
| Rate for Payer: Molina Healthcare Passport |
$130.48
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$188.63
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$145.10
|
|
