|
CRESEMBA(ISAV) 1MG (372MG/5ML)
|
Facility
|
IP
|
$974.38
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
25003844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$935.40 |
| Rate for Payer: Aetna Commercial |
$750.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.02
|
| Rate for Payer: Cash Price |
$487.19
|
| Rate for Payer: Cigna Commercial |
$808.74
|
| Rate for Payer: First Health Commercial |
$925.66
|
| Rate for Payer: Humana Commercial |
$828.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$798.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$857.45
|
| Rate for Payer: Ohio Health Group HMO |
$730.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$779.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$847.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.32
|
| Rate for Payer: PHCS Commercial |
$935.40
|
| Rate for Payer: United Healthcare All Payer |
$857.45
|
|
|
CRESEMBA(ISAVUCONAZ) 186MG CAP
|
Facility
|
OP
|
$285.75
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
25003843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$274.32 |
| Rate for Payer: Aetna Commercial |
$220.03
|
| Rate for Payer: Anthem Medicaid |
$98.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.36
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cigna Commercial |
$237.17
|
| Rate for Payer: First Health Commercial |
$271.46
|
| Rate for Payer: Humana Commercial |
$242.89
|
| Rate for Payer: Humana KY Medicaid |
$98.27
|
| Rate for Payer: Humana Medicare Advantage |
$1.01
|
| Rate for Payer: Kentucky WC Medicaid |
$99.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.46
|
| Rate for Payer: Ohio Health Group HMO |
$214.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.17
|
| Rate for Payer: PHCS Commercial |
$274.32
|
| Rate for Payer: United Healthcare All Payer |
$251.46
|
|
|
CRESEMBA(ISAVUCONAZ) 186MG CAP
|
Facility
|
IP
|
$285.75
|
|
|
Service Code
|
HCPCS J1833
|
| Hospital Charge Code |
25003843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.72 |
| Max. Negotiated Rate |
$274.32 |
| Rate for Payer: Aetna Commercial |
$220.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.88
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cigna Commercial |
$237.17
|
| Rate for Payer: First Health Commercial |
$271.46
|
| Rate for Payer: Humana Commercial |
$242.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.46
|
| Rate for Payer: Ohio Health Group HMO |
$214.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.17
|
| Rate for Payer: PHCS Commercial |
$274.32
|
| Rate for Payer: United Healthcare All Payer |
$251.46
|
|
|
CRESTOR 20MG TABLET
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 27808015701
|
| Hospital Charge Code |
25000495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| 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 |
$3.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
CRESTOR 20MG TABLET
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 27808015701
|
| Hospital Charge Code |
25000495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| 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 |
$3.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| 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 |
$1.28 |
| 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 |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| 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 |
$1.28 |
| 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 |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| 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 |
$18.03 |
| 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 |
$48.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.46
|
| 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 |
$18.03 |
| 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 |
$48.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.46
|
| Rate for Payer: PHCS Commercial |
$57.69
|
| Rate for Payer: United Healthcare All Payer |
$52.88
|
|
|
CRESTOR(ROSUVASTATIN CAL)10MGT
|
Facility
|
IP
|
$9.15
|
|
|
Service Code
|
NDC 60687024565
|
| Hospital Charge Code |
25000497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| 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 |
$2.75
|
| 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 |
$7.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.31
|
| Rate for Payer: PHCS Commercial |
$8.78
|
| Rate for Payer: United Healthcare All Payer |
$8.05
|
|
|
CRESTOR(ROSUVASTATIN CAL)10MGT
|
Facility
|
OP
|
$9.15
|
|
|
Service Code
|
NDC 60687024565
|
| Hospital Charge Code |
25000497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| 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 |
$2.75
|
| 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 |
$7.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.31
|
| Rate for Payer: PHCS Commercial |
$8.78
|
| Rate for Payer: United Healthcare All Payer |
$8.05
|
|
|
CR FIXED BEARING 3-11 E-F
|
Facility
|
OP
|
$9,068.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,720.44 |
| Max. Negotiated Rate |
$8,705.40 |
| Rate for Payer: Aetna Commercial |
$6,982.45
|
| Rate for Payer: Anthem Medicaid |
$3,118.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,073.13
|
| Rate for Payer: Cash Price |
$4,534.06
|
| Rate for Payer: Cigna Commercial |
$7,526.54
|
| Rate for Payer: First Health Commercial |
$8,614.71
|
| Rate for Payer: Humana Commercial |
$7,707.90
|
| Rate for Payer: Humana KY Medicaid |
$3,118.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,150.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,435.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,692.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,720.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,181.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,979.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,801.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,254.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,889.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,257.00
|
| Rate for Payer: PHCS Commercial |
$8,705.40
|
| Rate for Payer: United Healthcare All Payer |
$7,979.95
|
|
|
CR FIXED BEARING 3-11 E-F
|
Facility
|
IP
|
$9,068.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,720.44 |
| Max. Negotiated Rate |
$8,705.40 |
| Rate for Payer: Aetna Commercial |
$6,982.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,073.13
|
| Rate for Payer: Cash Price |
$4,534.06
|
| Rate for Payer: Cigna Commercial |
$7,526.54
|
| Rate for Payer: First Health Commercial |
$8,614.71
|
| Rate for Payer: Humana Commercial |
$7,707.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,435.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,692.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,720.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,979.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,801.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,254.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,889.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,257.00
|
| Rate for Payer: PHCS Commercial |
$8,705.40
|
| Rate for Payer: United Healthcare All Payer |
$7,979.95
|
|
|
CR FLEX ART SUR C-H/3 4 YEL 10
|
Facility
|
OP
|
$7,334.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.31 |
| Max. Negotiated Rate |
$7,041.00 |
| Rate for Payer: Aetna Commercial |
$5,647.47
|
| Rate for Payer: Anthem Medicaid |
$2,522.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,720.82
|
| Rate for Payer: Cash Price |
$3,667.19
|
| Rate for Payer: Cigna Commercial |
$6,087.54
|
| Rate for Payer: First Health Commercial |
$6,967.66
|
| Rate for Payer: Humana Commercial |
$6,234.22
|
| Rate for Payer: Humana KY Medicaid |
$2,522.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,547.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,014.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,412.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,572.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,454.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,500.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,867.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,380.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,060.72
|
| Rate for Payer: PHCS Commercial |
$7,041.00
|
| Rate for Payer: United Healthcare All Payer |
$6,454.25
|
|
|
CR FLEX ART SUR C-H/3 4 YEL 10
|
Facility
|
IP
|
$7,334.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.31 |
| Max. Negotiated Rate |
$7,041.00 |
| Rate for Payer: Aetna Commercial |
$5,647.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,720.82
|
| Rate for Payer: Cash Price |
$3,667.19
|
| Rate for Payer: Cigna Commercial |
$6,087.54
|
| Rate for Payer: First Health Commercial |
$6,967.66
|
| Rate for Payer: Humana Commercial |
$6,234.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,014.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,412.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,454.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,500.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,867.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,380.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,060.72
|
| Rate for Payer: PHCS Commercial |
$7,041.00
|
| Rate for Payer: United Healthcare All Payer |
$6,454.25
|
|
|
CR FLEX ART SUR C-H/3 4 YEL 12
|
Facility
|
OP
|
$7,334.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.31 |
| Max. Negotiated Rate |
$7,041.00 |
| Rate for Payer: Aetna Commercial |
$5,647.47
|
| Rate for Payer: Anthem Medicaid |
$2,522.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,720.82
|
| Rate for Payer: Cash Price |
$3,667.19
|
| Rate for Payer: Cigna Commercial |
$6,087.54
|
| Rate for Payer: First Health Commercial |
$6,967.66
|
| Rate for Payer: Humana Commercial |
$6,234.22
|
| Rate for Payer: Humana KY Medicaid |
$2,522.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,547.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,014.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,412.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,572.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,454.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,500.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,867.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,380.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,060.72
|
| Rate for Payer: PHCS Commercial |
$7,041.00
|
| Rate for Payer: United Healthcare All Payer |
$6,454.25
|
|
|
CR FLEX ART SUR C-H/3 4 YEL 12
|
Facility
|
IP
|
$7,334.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.31 |
| Max. Negotiated Rate |
$7,041.00 |
| Rate for Payer: Aetna Commercial |
$5,647.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,720.82
|
| Rate for Payer: Cash Price |
$3,667.19
|
| Rate for Payer: Cigna Commercial |
$6,087.54
|
| Rate for Payer: First Health Commercial |
$6,967.66
|
| Rate for Payer: Humana Commercial |
$6,234.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,014.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,412.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,454.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,500.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,867.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,380.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,060.72
|
| Rate for Payer: PHCS Commercial |
$7,041.00
|
| Rate for Payer: United Healthcare All Payer |
$6,454.25
|
|
|
CR FLEX ART SUR C-H/3 4 YEL 14
|
Facility
|
IP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
CR FLEX ART SUR C-H/3 4 YEL 14
|
Facility
|
OP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem Medicaid |
$2,641.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Humana KY Medicaid |
$2,641.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
CR FLEX ART SUR C-H/5 6 GRN 10
|
Facility
|
IP
|
$7,334.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.31 |
| Max. Negotiated Rate |
$7,041.00 |
| Rate for Payer: Aetna Commercial |
$5,647.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,720.82
|
| Rate for Payer: Cash Price |
$3,667.19
|
| Rate for Payer: Cigna Commercial |
$6,087.54
|
| Rate for Payer: First Health Commercial |
$6,967.66
|
| Rate for Payer: Humana Commercial |
$6,234.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,014.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,412.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,454.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,500.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,867.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,380.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,060.72
|
| Rate for Payer: PHCS Commercial |
$7,041.00
|
| Rate for Payer: United Healthcare All Payer |
$6,454.25
|
|
|
CR FLEX ART SUR C-H/5 6 GRN 10
|
Facility
|
OP
|
$7,334.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.31 |
| Max. Negotiated Rate |
$7,041.00 |
| Rate for Payer: Aetna Commercial |
$5,647.47
|
| Rate for Payer: Anthem Medicaid |
$2,522.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,720.82
|
| Rate for Payer: Cash Price |
$3,667.19
|
| Rate for Payer: Cigna Commercial |
$6,087.54
|
| Rate for Payer: First Health Commercial |
$6,967.66
|
| Rate for Payer: Humana Commercial |
$6,234.22
|
| Rate for Payer: Humana KY Medicaid |
$2,522.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,547.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,014.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,412.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,572.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,454.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,500.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,867.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,380.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,060.72
|
| Rate for Payer: PHCS Commercial |
$7,041.00
|
| Rate for Payer: United Healthcare All Payer |
$6,454.25
|
|
|
CR FLEX ART SUR C-H/5 6 GRN 12
|
Facility
|
OP
|
$7,334.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.31 |
| Max. Negotiated Rate |
$7,041.00 |
| Rate for Payer: Aetna Commercial |
$5,647.47
|
| Rate for Payer: Anthem Medicaid |
$2,522.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,720.82
|
| Rate for Payer: Cash Price |
$3,667.19
|
| Rate for Payer: Cigna Commercial |
$6,087.54
|
| Rate for Payer: First Health Commercial |
$6,967.66
|
| Rate for Payer: Humana Commercial |
$6,234.22
|
| Rate for Payer: Humana KY Medicaid |
$2,522.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,547.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,014.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,412.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,572.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,454.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,500.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,867.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,380.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,060.72
|
| Rate for Payer: PHCS Commercial |
$7,041.00
|
| Rate for Payer: United Healthcare All Payer |
$6,454.25
|
|
|
CR FLEX ART SUR C-H/5 6 GRN 12
|
Facility
|
IP
|
$7,334.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.31 |
| Max. Negotiated Rate |
$7,041.00 |
| Rate for Payer: Aetna Commercial |
$5,647.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,720.82
|
| Rate for Payer: Cash Price |
$3,667.19
|
| Rate for Payer: Cigna Commercial |
$6,087.54
|
| Rate for Payer: First Health Commercial |
$6,967.66
|
| Rate for Payer: Humana Commercial |
$6,234.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,014.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,412.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,454.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,500.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,867.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,380.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,060.72
|
| Rate for Payer: PHCS Commercial |
$7,041.00
|
| Rate for Payer: United Healthcare All Payer |
$6,454.25
|
|
|
CR FLEX ART SUR C-H/5 6 GRN 14
|
Facility
|
IP
|
$7,334.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.31 |
| Max. Negotiated Rate |
$7,041.00 |
| Rate for Payer: Aetna Commercial |
$5,647.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,720.82
|
| Rate for Payer: Cash Price |
$3,667.19
|
| Rate for Payer: Cigna Commercial |
$6,087.54
|
| Rate for Payer: First Health Commercial |
$6,967.66
|
| Rate for Payer: Humana Commercial |
$6,234.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,014.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,412.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,454.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,500.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,867.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,380.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,060.72
|
| Rate for Payer: PHCS Commercial |
$7,041.00
|
| Rate for Payer: United Healthcare All Payer |
$6,454.25
|
|
|
CR FLEX ART SUR C-H/5 6 GRN 14
|
Facility
|
OP
|
$7,334.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.31 |
| Max. Negotiated Rate |
$7,041.00 |
| Rate for Payer: Aetna Commercial |
$5,647.47
|
| Rate for Payer: Anthem Medicaid |
$2,522.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,720.82
|
| Rate for Payer: Cash Price |
$3,667.19
|
| Rate for Payer: Cigna Commercial |
$6,087.54
|
| Rate for Payer: First Health Commercial |
$6,967.66
|
| Rate for Payer: Humana Commercial |
$6,234.22
|
| Rate for Payer: Humana KY Medicaid |
$2,522.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,547.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,014.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,412.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,572.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,454.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,500.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,867.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,380.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,060.72
|
| Rate for Payer: PHCS Commercial |
$7,041.00
|
| Rate for Payer: United Healthcare All Payer |
$6,454.25
|
|
