|
AMINOACID 5% DEX 15% S 1000ML
|
Facility
|
IP
|
$107.98
|
|
|
Service Code
|
NDC 338113703
|
| Hospital Charge Code |
25002824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.66 |
| Rate for Payer: Aetna Commercial |
$83.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.22
|
| Rate for Payer: Cash Price |
$53.99
|
| Rate for Payer: Cigna Commercial |
$89.62
|
| Rate for Payer: First Health Commercial |
$102.58
|
| Rate for Payer: Humana Commercial |
$91.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.02
|
| Rate for Payer: Ohio Health Group HMO |
$80.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.47
|
| Rate for Payer: PHCS Commercial |
$103.66
|
| Rate for Payer: United Healthcare All Payer |
$95.02
|
|
|
AMINOACID 5% DEX 15% S 1000ML
|
Facility
|
OP
|
$107.98
|
|
|
Service Code
|
NDC 338113703
|
| Hospital Charge Code |
25002824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.66 |
| Rate for Payer: Humana Commercial |
$91.78
|
| Rate for Payer: Humana KY Medicaid |
$37.13
|
| Rate for Payer: Kentucky WC Medicaid |
$37.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.02
|
| Rate for Payer: Ohio Health Group HMO |
$80.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.47
|
| Rate for Payer: PHCS Commercial |
$103.66
|
| Rate for Payer: United Healthcare All Payer |
$95.02
|
| Rate for Payer: Aetna Commercial |
$83.14
|
| Rate for Payer: Anthem Medicaid |
$37.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.22
|
| Rate for Payer: Cash Price |
$53.99
|
| Rate for Payer: Cigna Commercial |
$89.62
|
| Rate for Payer: First Health Commercial |
$102.58
|
|
|
AMINOPHYLLINE 500MG/20ML
|
Facility
|
OP
|
$116.21
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
25002827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$111.56 |
| Rate for Payer: Aetna Commercial |
$89.48
|
| Rate for Payer: Anthem Medicaid |
$39.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.64
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: Cigna Commercial |
$96.45
|
| Rate for Payer: First Health Commercial |
$110.40
|
| Rate for Payer: Humana Commercial |
$98.78
|
| Rate for Payer: Humana KY Medicaid |
$39.96
|
| Rate for Payer: Kentucky WC Medicaid |
$40.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.26
|
| Rate for Payer: Ohio Health Group HMO |
$87.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.03
|
| Rate for Payer: PHCS Commercial |
$111.56
|
| Rate for Payer: United Healthcare All Payer |
$102.26
|
|
|
AMINOPHYLLINE 500MG/20ML
|
Facility
|
IP
|
$116.21
|
|
|
Service Code
|
HCPCS J0280
|
| Hospital Charge Code |
25002827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$111.56 |
| Rate for Payer: Aetna Commercial |
$89.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.64
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: Cigna Commercial |
$96.45
|
| Rate for Payer: First Health Commercial |
$110.40
|
| Rate for Payer: Humana Commercial |
$98.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.26
|
| Rate for Payer: Ohio Health Group HMO |
$87.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.03
|
| Rate for Payer: PHCS Commercial |
$111.56
|
| Rate for Payer: United Healthcare All Payer |
$102.26
|
|
|
AMINOPHYLLINE (THEOPH)
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 80198
|
| Hospital Charge Code |
30000049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
AMINOPHYLLINE (THEOPH)
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 80198
|
| Hospital Charge Code |
30000049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$14.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$14.14
|
| Rate for Payer: Humana Medicare Advantage |
$14.14
|
| Rate for Payer: Kentucky WC Medicaid |
$14.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
AMINOSYN II 10% 500ML
|
Facility
|
OP
|
$190.24
|
|
|
Service Code
|
NDC 990717217
|
| Hospital Charge Code |
25002828
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$182.63 |
| Rate for Payer: Aetna Commercial |
$146.48
|
| Rate for Payer: Anthem Medicaid |
$65.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.39
|
| Rate for Payer: Cash Price |
$95.12
|
| Rate for Payer: Cigna Commercial |
$157.90
|
| Rate for Payer: First Health Commercial |
$180.73
|
| Rate for Payer: Humana Commercial |
$161.70
|
| Rate for Payer: Humana KY Medicaid |
$65.42
|
| Rate for Payer: Kentucky WC Medicaid |
$66.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.41
|
| Rate for Payer: Ohio Health Group HMO |
$142.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.97
|
| Rate for Payer: PHCS Commercial |
$182.63
|
| Rate for Payer: United Healthcare All Payer |
$167.41
|
|
|
AMINOSYN II 10% 500ML
|
Facility
|
IP
|
$190.24
|
|
|
Service Code
|
NDC 990717217
|
| Hospital Charge Code |
25002828
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$182.63 |
| Rate for Payer: Aetna Commercial |
$146.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.39
|
| Rate for Payer: Cash Price |
$95.12
|
| Rate for Payer: Cigna Commercial |
$157.90
|
| Rate for Payer: First Health Commercial |
$180.73
|
| Rate for Payer: Humana Commercial |
$161.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.41
|
| Rate for Payer: Ohio Health Group HMO |
$142.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.97
|
| Rate for Payer: PHCS Commercial |
$182.63
|
| Rate for Payer: United Healthcare All Payer |
$167.41
|
|
|
AMINOSYN II 15% IV SOLU 2000ML
|
Facility
|
IP
|
$198.24
|
|
|
Service Code
|
NDC 990717117
|
| Hospital Charge Code |
25002829
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$190.31 |
| Rate for Payer: Aetna Commercial |
$152.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.63
|
| Rate for Payer: Cash Price |
$99.12
|
| Rate for Payer: Cigna Commercial |
$164.54
|
| Rate for Payer: First Health Commercial |
$188.33
|
| Rate for Payer: Humana Commercial |
$168.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.45
|
| Rate for Payer: Ohio Health Group HMO |
$148.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.45
|
| Rate for Payer: PHCS Commercial |
$190.31
|
| Rate for Payer: United Healthcare All Payer |
$174.45
|
|
|
AMINOSYN II 15% IV SOLU 2000ML
|
Facility
|
OP
|
$198.24
|
|
|
Service Code
|
NDC 990717117
|
| Hospital Charge Code |
25002829
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$190.31 |
| Rate for Payer: Aetna Commercial |
$152.64
|
| Rate for Payer: Anthem Medicaid |
$68.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.63
|
| Rate for Payer: Cash Price |
$99.12
|
| Rate for Payer: Cigna Commercial |
$164.54
|
| Rate for Payer: First Health Commercial |
$188.33
|
| Rate for Payer: Humana Commercial |
$168.50
|
| Rate for Payer: Humana KY Medicaid |
$68.17
|
| Rate for Payer: Kentucky WC Medicaid |
$68.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.45
|
| Rate for Payer: Ohio Health Group HMO |
$148.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.45
|
| Rate for Payer: PHCS Commercial |
$190.31
|
| Rate for Payer: United Healthcare All Payer |
$174.45
|
|
|
AMITIZA 24 MCG CAP
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 65162084206
|
| Hospital Charge Code |
25000211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.79
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
AMITIZA 24 MCG CAP
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 65162084206
|
| Hospital Charge Code |
25000211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem Medicaid |
$3.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Humana KY Medicaid |
$3.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.79
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
AMITIZA 8 MCG CAPSULE
|
Facility
|
OP
|
$23.19
|
|
|
Service Code
|
NDC 64764008060
|
| Hospital Charge Code |
25000212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$22.26 |
| Rate for Payer: Aetna Commercial |
$17.86
|
| Rate for Payer: Anthem Medicaid |
$7.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.09
|
| Rate for Payer: Cash Price |
$11.60
|
| Rate for Payer: Cigna Commercial |
$19.25
|
| Rate for Payer: First Health Commercial |
$22.03
|
| Rate for Payer: Humana Commercial |
$19.71
|
| Rate for Payer: Humana KY Medicaid |
$7.98
|
| Rate for Payer: Kentucky WC Medicaid |
$8.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.41
|
| Rate for Payer: Ohio Health Group HMO |
$17.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.19
|
| Rate for Payer: PHCS Commercial |
$22.26
|
| Rate for Payer: United Healthcare All Payer |
$20.41
|
|
|
AMITIZA 8 MCG CAPSULE
|
Facility
|
IP
|
$23.19
|
|
|
Service Code
|
NDC 64764008060
|
| Hospital Charge Code |
25000212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$22.26 |
| Rate for Payer: Aetna Commercial |
$17.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.09
|
| Rate for Payer: Cash Price |
$11.60
|
| Rate for Payer: Cigna Commercial |
$19.25
|
| Rate for Payer: First Health Commercial |
$22.03
|
| Rate for Payer: Humana Commercial |
$19.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.41
|
| Rate for Payer: Ohio Health Group HMO |
$17.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.19
|
| Rate for Payer: PHCS Commercial |
$22.26
|
| Rate for Payer: United Healthcare All Payer |
$20.41
|
|
|
AMK LEG I PINS 50MM
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$2,102.40 |
| Rate for Payer: Aetna Commercial |
$1,686.30
|
| Rate for Payer: Anthem Medicaid |
$753.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cigna Commercial |
$1,817.70
|
| Rate for Payer: First Health Commercial |
$2,080.50
|
| Rate for Payer: Humana Commercial |
$1,861.50
|
| Rate for Payer: Humana KY Medicaid |
$753.14
|
| Rate for Payer: Kentucky WC Medicaid |
$760.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,795.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,642.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.90
|
| Rate for Payer: PHCS Commercial |
$2,102.40
|
| Rate for Payer: United Healthcare All Payer |
$1,927.20
|
|
|
AMK LEG I PINS 50MM
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$2,102.40 |
| Rate for Payer: Aetna Commercial |
$1,686.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cigna Commercial |
$1,817.70
|
| Rate for Payer: First Health Commercial |
$2,080.50
|
| Rate for Payer: Humana Commercial |
$1,861.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,795.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,642.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.90
|
| Rate for Payer: PHCS Commercial |
$2,102.40
|
| Rate for Payer: United Healthcare All Payer |
$1,927.20
|
|
|
AMK PRIMARY LOCKING PIN
|
Facility
|
OP
|
$4,681.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.60 |
| Max. Negotiated Rate |
$4,494.24 |
| Rate for Payer: Aetna Commercial |
$3,604.76
|
| Rate for Payer: Anthem Medicaid |
$1,609.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,651.57
|
| Rate for Payer: Cash Price |
$2,340.75
|
| Rate for Payer: Cigna Commercial |
$3,885.64
|
| Rate for Payer: First Health Commercial |
$4,447.42
|
| Rate for Payer: Humana Commercial |
$3,979.28
|
| Rate for Payer: Humana KY Medicaid |
$1,609.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,626.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,838.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,454.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,404.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,642.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,119.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,511.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,451.26
|
| Rate for Payer: PHCS Commercial |
$4,494.24
|
| Rate for Payer: United Healthcare All Payer |
$4,119.72
|
|
|
AMK PRIMARY LOCKING PIN
|
Facility
|
IP
|
$4,681.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.60 |
| Max. Negotiated Rate |
$4,494.24 |
| Rate for Payer: Aetna Commercial |
$3,604.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,651.57
|
| Rate for Payer: Cash Price |
$2,340.75
|
| Rate for Payer: Cigna Commercial |
$3,885.64
|
| Rate for Payer: First Health Commercial |
$4,447.42
|
| Rate for Payer: Humana Commercial |
$3,979.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,838.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,454.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,404.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,119.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,511.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,451.26
|
| Rate for Payer: PHCS Commercial |
$4,494.24
|
| Rate for Payer: United Healthcare All Payer |
$4,119.72
|
|
|
AML SM 10.5MM FEM STEM
|
Facility
|
IP
|
$22,166.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.67 |
| Max. Negotiated Rate |
$21,280.03 |
| Rate for Payer: Aetna Commercial |
$17,068.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,290.03
|
| Rate for Payer: Cash Price |
$11,083.35
|
| Rate for Payer: Cigna Commercial |
$18,398.36
|
| Rate for Payer: First Health Commercial |
$21,058.36
|
| Rate for Payer: Humana Commercial |
$18,841.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,176.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,359.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,650.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,506.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,625.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,433.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,871.68
|
| Rate for Payer: PHCS Commercial |
$21,280.03
|
| Rate for Payer: United Healthcare All Payer |
$19,506.70
|
|
|
AML SM 10.5MM FEM STEM
|
Facility
|
OP
|
$22,166.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.67 |
| Max. Negotiated Rate |
$21,280.03 |
| Rate for Payer: Aetna Commercial |
$17,068.36
|
| Rate for Payer: Anthem Medicaid |
$7,623.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,290.03
|
| Rate for Payer: Cash Price |
$11,083.35
|
| Rate for Payer: Cigna Commercial |
$18,398.36
|
| Rate for Payer: First Health Commercial |
$21,058.36
|
| Rate for Payer: Humana Commercial |
$18,841.70
|
| Rate for Payer: Humana KY Medicaid |
$7,623.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,700.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,176.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,359.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,650.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,776.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,506.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,625.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,433.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,871.68
|
| Rate for Payer: PHCS Commercial |
$21,280.03
|
| Rate for Payer: United Healthcare All Payer |
$19,506.70
|
|
|
AML SM 12.0MM FEM STEM
|
Facility
|
OP
|
$22,166.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.67 |
| Max. Negotiated Rate |
$21,280.03 |
| Rate for Payer: Aetna Commercial |
$17,068.36
|
| Rate for Payer: Anthem Medicaid |
$7,623.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,290.03
|
| Rate for Payer: Cash Price |
$11,083.35
|
| Rate for Payer: Cigna Commercial |
$18,398.36
|
| Rate for Payer: First Health Commercial |
$21,058.36
|
| Rate for Payer: Humana Commercial |
$18,841.70
|
| Rate for Payer: Humana KY Medicaid |
$7,623.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,700.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,176.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,359.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,650.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,776.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,506.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,625.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,433.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,871.68
|
| Rate for Payer: PHCS Commercial |
$21,280.03
|
| Rate for Payer: United Healthcare All Payer |
$19,506.70
|
|
|
AML SM 12.0MM FEM STEM
|
Facility
|
IP
|
$22,166.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,881.67 |
| Max. Negotiated Rate |
$21,280.03 |
| Rate for Payer: Aetna Commercial |
$17,068.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,290.03
|
| Rate for Payer: Cash Price |
$11,083.35
|
| Rate for Payer: Cigna Commercial |
$18,398.36
|
| Rate for Payer: First Health Commercial |
$21,058.36
|
| Rate for Payer: Humana Commercial |
$18,841.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,176.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,359.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,650.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,506.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,625.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,433.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,881.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,871.68
|
| Rate for Payer: PHCS Commercial |
$21,280.03
|
| Rate for Payer: United Healthcare All Payer |
$19,506.70
|
|
|
AMMONIA
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
30000237
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$14.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.57
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$14.57
|
| Rate for Payer: Humana Medicare Advantage |
$14.57
|
| Rate for Payer: Kentucky WC Medicaid |
$14.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.94
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
AMMONIA
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
30000237
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.94
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
AMNIO ALLOGFT PLACEN MATRI 2*2
|
Facility
|
IP
|
$5,623.88
|
|
|
Service Code
|
HCPCS Q4151
|
| Hospital Charge Code |
27000287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.10 |
| Max. Negotiated Rate |
$5,398.92 |
| Rate for Payer: Aetna Commercial |
$4,330.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,386.63
|
| Rate for Payer: Cash Price |
$2,811.94
|
| Rate for Payer: Cigna Commercial |
$4,667.82
|
| Rate for Payer: First Health Commercial |
$5,342.69
|
| Rate for Payer: Humana Commercial |
$4,780.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,611.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,150.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,687.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,949.01
|
| Rate for Payer: Ohio Health Group HMO |
$4,217.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$731.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,743.40
|
| Rate for Payer: PHCS Commercial |
$5,398.92
|
| Rate for Payer: United Healthcare All Payer |
$4,949.01
|
|
