|
ALPROSTADIL 1.25mcg(40mcg SDV)
|
Facility
|
IP
|
$747.47
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25004268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$224.24 |
| Max. Negotiated Rate |
$717.57 |
| Rate for Payer: Aetna Commercial |
$575.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.03
|
| Rate for Payer: Cash Price |
$373.74
|
| Rate for Payer: Cigna Commercial |
$620.40
|
| Rate for Payer: First Health Commercial |
$710.10
|
| Rate for Payer: Humana Commercial |
$635.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$612.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$551.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$657.77
|
| Rate for Payer: Ohio Health Group HMO |
$560.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$597.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$515.75
|
| Rate for Payer: PHCS Commercial |
$717.57
|
| Rate for Payer: United Healthcare All Payer |
$657.77
|
|
|
ALTACE RAMIPRIL 1.25MG CAP
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 68382014406
|
| Hospital Charge Code |
25000202
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
ALTACE RAMIPRIL 1.25MG CAP
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 68382014406
|
| Hospital Charge Code |
25000202
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
ALTACE (RAMIPRIL) 2.5MG/1CAP
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
25000200
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
ALTACE (RAMIPRIL) 2.5MG/1CAP
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
25000200
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.03
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
ALTACE (RAMIPRIL) 5MG/1CAP
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
25000201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
ALTACE (RAMIPRIL) 5MG/1CAP
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
25000201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
ALTERNARIA TENUIS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000794
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
ALTERNARIA TENUIS IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000794
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
ALTRX +4 10D LNR 32 X 48
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 10D LNR 32 X 48
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 10D LNR 32 X 50
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 10D LNR 32 X 50
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 10D LNR 32 X 52
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 10D LNR 32 X 52
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 10D LNR 32 X 54
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 10D LNR 32 X 54
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 10D LNR 36 X 52
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 10D LNR 36 X 52
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 10D LNR 36 X 54
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 10D LNR 36 X 54
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 10D LNR 36 X 56
|
Facility
|
OP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem Medicaid |
$1,590.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Humana KY Medicaid |
$1,590.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,606.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
ALTRX +4 10D LNR 36 X 56
|
Facility
|
IP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
ALTRX +4 10D LNR 36 X 58
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4 10D LNR 36 X 58
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
