|
CRESEMBA(ISAV) 1MG (372MG/5ML)
|
Facility
|
IP
|
$962.89
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
25003844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.18 |
| Max. Negotiated Rate |
$924.37 |
| Rate for Payer: Aetna Commercial |
$741.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$751.05
|
| Rate for Payer: Cash Price |
$481.44
|
| Rate for Payer: Cigna Commercial |
$799.20
|
| Rate for Payer: First Health Commercial |
$914.75
|
| Rate for Payer: Humana Commercial |
$818.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$789.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$710.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$288.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$847.34
|
| Rate for Payer: Ohio Health Group HMO |
$722.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.50
|
| Rate for Payer: PHCS Commercial |
$924.37
|
| Rate for Payer: United Healthcare All Payer |
$847.34
|
|
|
CRESEMBA(ISAV) 1MG (372MG/5ML)
|
Facility
|
OP
|
$962.89
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
25003844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$924.37 |
| Rate for Payer: Aetna Commercial |
$741.43
|
| Rate for Payer: Anthem Medicaid |
$331.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$751.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.27
|
| Rate for Payer: Cash Price |
$481.44
|
| Rate for Payer: Cash Price |
$481.44
|
| Rate for Payer: Cigna Commercial |
$799.20
|
| Rate for Payer: First Health Commercial |
$914.75
|
| Rate for Payer: Humana Commercial |
$818.46
|
| Rate for Payer: Humana KY Medicaid |
$331.14
|
| Rate for Payer: Humana Medicare Advantage |
$0.94
|
| Rate for Payer: Kentucky WC Medicaid |
$334.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$789.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$710.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$337.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$847.34
|
| Rate for Payer: Ohio Health Group HMO |
$722.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.50
|
| Rate for Payer: PHCS Commercial |
$924.37
|
| Rate for Payer: United Healthcare All Payer |
$847.34
|
|
|
CRESEMBA(ISAVUCONAZ) 186MG CAP
|
Facility
|
OP
|
$282.38
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
25003843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$271.08 |
| Rate for Payer: Aetna Commercial |
$217.43
|
| Rate for Payer: Anthem Medicaid |
$97.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$220.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.27
|
| Rate for Payer: Cash Price |
$141.19
|
| Rate for Payer: Cash Price |
$141.19
|
| Rate for Payer: Cigna Commercial |
$234.38
|
| Rate for Payer: First Health Commercial |
$268.26
|
| Rate for Payer: Humana Commercial |
$240.02
|
| Rate for Payer: Humana KY Medicaid |
$97.11
|
| Rate for Payer: Humana Medicare Advantage |
$0.94
|
| Rate for Payer: Kentucky WC Medicaid |
$98.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$231.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$99.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$248.49
|
| Rate for Payer: Ohio Health Group HMO |
$211.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.54
|
| Rate for Payer: PHCS Commercial |
$271.08
|
| Rate for Payer: United Healthcare All Payer |
$248.49
|
|
|
CRESEMBA(ISAVUCONAZ) 186MG CAP
|
Facility
|
IP
|
$282.38
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
25003843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.71 |
| Max. Negotiated Rate |
$271.08 |
| Rate for Payer: Aetna Commercial |
$217.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$220.26
|
| Rate for Payer: Cash Price |
$141.19
|
| Rate for Payer: Cigna Commercial |
$234.38
|
| Rate for Payer: First Health Commercial |
$268.26
|
| Rate for Payer: Humana Commercial |
$240.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$231.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$248.49
|
| Rate for Payer: Ohio Health Group HMO |
$211.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.54
|
| Rate for Payer: PHCS Commercial |
$271.08
|
| Rate for Payer: United Healthcare All Payer |
$248.49
|
|
|
CRESTOR 20MG TABLET
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 27808015701
|
| Hospital Charge Code |
25000495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
CRESTOR 20MG TABLET
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 27808015701
|
| Hospital Charge Code |
25000495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
CRESTOR 5 MG TABLET
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
NDC 65862029390
|
| Hospital Charge Code |
25000496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.06
|
| Rate for Payer: Humana Commercial |
$3.63
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.76
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Payer |
$3.76
|
|
|
CRESTOR 5 MG TABLET
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
NDC 65862029390
|
| Hospital Charge Code |
25000496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.06
|
| Rate for Payer: Humana Commercial |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.76
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Payer |
$3.76
|
|
|
[C]RESTORIL (TEMAZEP 15MG/1CAP
|
Facility
|
IP
|
$60.09
|
|
|
Service Code
|
NDC 228207610
|
| Hospital Charge Code |
25000117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$57.69 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.87
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cigna Commercial |
$49.87
|
| Rate for Payer: First Health Commercial |
$57.09
|
| Rate for Payer: Humana Commercial |
$51.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.88
|
| Rate for Payer: Ohio Health Group HMO |
$45.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.63
|
| Rate for Payer: PHCS Commercial |
$57.69
|
| Rate for Payer: United Healthcare All Payer |
$52.88
|
|
|
[C]RESTORIL (TEMAZEP 15MG/1CAP
|
Facility
|
OP
|
$60.09
|
|
|
Service Code
|
NDC 228207610
|
| Hospital Charge Code |
25000117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$57.69 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Anthem Medicaid |
$20.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.87
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cigna Commercial |
$49.87
|
| Rate for Payer: First Health Commercial |
$57.09
|
| Rate for Payer: Humana Commercial |
$51.08
|
| Rate for Payer: Humana KY Medicaid |
$20.66
|
| Rate for Payer: Kentucky WC Medicaid |
$20.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.88
|
| Rate for Payer: Ohio Health Group HMO |
$45.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.63
|
| Rate for Payer: PHCS Commercial |
$57.69
|
| Rate for Payer: United Healthcare All Payer |
$52.88
|
|
|
CRESTOR(ROSUVASTATIN CAL)10MGT
|
Facility
|
OP
|
$9.15
|
|
|
Service Code
|
NDC 60687024565
|
| Hospital Charge Code |
25000497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Anthem Medicaid |
$3.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.59
|
| Rate for Payer: First Health Commercial |
$8.69
|
| Rate for Payer: Humana Commercial |
$7.78
|
| Rate for Payer: Humana KY Medicaid |
$3.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.05
|
| Rate for Payer: Ohio Health Group HMO |
$6.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.84
|
| Rate for Payer: PHCS Commercial |
$8.78
|
| Rate for Payer: United Healthcare All Payer |
$8.05
|
|
|
CRESTOR(ROSUVASTATIN CAL)10MGT
|
Facility
|
IP
|
$9.15
|
|
|
Service Code
|
NDC 60687024565
|
| Hospital Charge Code |
25000497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.59
|
| Rate for Payer: First Health Commercial |
$8.69
|
| Rate for Payer: Humana Commercial |
$7.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.05
|
| Rate for Payer: Ohio Health Group HMO |
$6.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.84
|
| Rate for Payer: PHCS Commercial |
$8.78
|
| Rate for Payer: United Healthcare All Payer |
$8.05
|
|
|
CR FIXED BEARING 3-11 E-F
|
Facility
|
IP
|
$8,868.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,152.86 |
| Max. Negotiated Rate |
$8,513.40 |
| Rate for Payer: Aetna Commercial |
$6,828.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,917.13
|
| Rate for Payer: Cash Price |
$4,434.06
|
| Rate for Payer: Cigna Commercial |
$7,360.54
|
| Rate for Payer: First Health Commercial |
$8,424.71
|
| Rate for Payer: Humana Commercial |
$7,537.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,271.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,544.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,660.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,803.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,651.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,773.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,152.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,749.12
|
| Rate for Payer: PHCS Commercial |
$8,513.40
|
| Rate for Payer: United Healthcare All Payer |
$7,803.95
|
|
|
CR FIXED BEARING 3-11 E-F
|
Facility
|
OP
|
$8,868.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,152.86 |
| Max. Negotiated Rate |
$8,513.40 |
| Rate for Payer: Aetna Commercial |
$6,828.45
|
| Rate for Payer: Anthem Medicaid |
$3,049.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,917.13
|
| Rate for Payer: Cash Price |
$4,434.06
|
| Rate for Payer: Cigna Commercial |
$7,360.54
|
| Rate for Payer: First Health Commercial |
$8,424.71
|
| Rate for Payer: Humana Commercial |
$7,537.90
|
| Rate for Payer: Humana KY Medicaid |
$3,049.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,080.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,271.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,544.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,660.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,110.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,803.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,651.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,773.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,152.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,749.12
|
| Rate for Payer: PHCS Commercial |
$8,513.40
|
| Rate for Payer: United Healthcare All Payer |
$7,803.95
|
|
|
CR FLEX ART SUR C-H/3 4 YEL 10
|
Facility
|
IP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
|
CR FLEX ART SUR C-H/3 4 YEL 10
|
Facility
|
OP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Anthem Medicaid |
$2,453.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Humana KY Medicaid |
$2,453.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,478.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,502.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
|
CR FLEX ART SUR C-H/3 4 YEL 12
|
Facility
|
IP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
|
CR FLEX ART SUR C-H/3 4 YEL 12
|
Facility
|
OP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Anthem Medicaid |
$2,453.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Humana KY Medicaid |
$2,453.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,478.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,502.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
|
CR FLEX ART SUR C-H/3 4 YEL 14
|
Facility
|
OP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem Medicaid |
$2,572.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana KY Medicaid |
$2,572.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
CR FLEX ART SUR C-H/3 4 YEL 14
|
Facility
|
IP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
CR FLEX ART SUR C-H/5 6 GRN 10
|
Facility
|
OP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Anthem Medicaid |
$2,453.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Humana KY Medicaid |
$2,453.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,478.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,502.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
|
CR FLEX ART SUR C-H/5 6 GRN 10
|
Facility
|
IP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
|
CR FLEX ART SUR C-H/5 6 GRN 12
|
Facility
|
OP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Anthem Medicaid |
$2,453.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Humana KY Medicaid |
$2,453.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,478.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,502.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
|
CR FLEX ART SUR C-H/5 6 GRN 12
|
Facility
|
IP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
|
CR FLEX ART SUR C-H/5 6 GRN 14
|
Facility
|
OP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Anthem Medicaid |
$2,453.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Humana KY Medicaid |
$2,453.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,478.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,502.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
