|
AMINOSYN II 15% IV SOLU 2000ML
|
Facility
|
IP
|
$323.68
|
|
|
Service Code
|
NDC 990717117
|
| Hospital Charge Code |
25002829
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$97.10 |
| Max. Negotiated Rate |
$310.73 |
| Rate for Payer: Aetna Commercial |
$249.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.47
|
| Rate for Payer: Cash Price |
$161.84
|
| Rate for Payer: Cigna Commercial |
$268.65
|
| Rate for Payer: First Health Commercial |
$307.50
|
| Rate for Payer: Humana Commercial |
$275.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$238.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$284.84
|
| Rate for Payer: Ohio Health Group HMO |
$242.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.34
|
| Rate for Payer: PHCS Commercial |
$310.73
|
| Rate for Payer: United Healthcare All Payer |
$284.84
|
|
|
AMITIZA 24 MCG CAP
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 65162084206
|
| Hospital Charge Code |
25000211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| 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 |
$7.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.21
|
| 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 |
$2.70 |
| 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 |
$7.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.21
|
| 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 |
$6.96 |
| 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 |
$18.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.00
|
| 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 |
$6.96 |
| 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 |
$18.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.00
|
| Rate for Payer: PHCS Commercial |
$22.26
|
| Rate for Payer: United Healthcare All Payer |
$20.41
|
|
|
AMK LEG I PINS 50MM
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.60 |
| Max. Negotiated Rate |
$2,123.52 |
| Rate for Payer: Aetna Commercial |
$1,703.24
|
| Rate for Payer: Anthem Medicaid |
$760.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,725.36
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: Cigna Commercial |
$1,835.96
|
| Rate for Payer: First Health Commercial |
$2,101.40
|
| Rate for Payer: Humana Commercial |
$1,880.20
|
| Rate for Payer: Humana KY Medicaid |
$760.71
|
| Rate for Payer: Kentucky WC Medicaid |
$768.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,632.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$775.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,946.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,924.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.28
|
| Rate for Payer: PHCS Commercial |
$2,123.52
|
| Rate for Payer: United Healthcare All Payer |
$1,946.56
|
|
|
AMK LEG I PINS 50MM
|
Facility
|
IP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.60 |
| Max. Negotiated Rate |
$2,123.52 |
| Rate for Payer: Aetna Commercial |
$1,703.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,725.36
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: Cigna Commercial |
$1,835.96
|
| Rate for Payer: First Health Commercial |
$2,101.40
|
| Rate for Payer: Humana Commercial |
$1,880.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,632.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,946.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,924.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.28
|
| Rate for Payer: PHCS Commercial |
$2,123.52
|
| Rate for Payer: United Healthcare All Payer |
$1,946.56
|
|
|
AMK PRIMARY LOCKING PIN
|
Facility
|
IP
|
$4,658.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.62 |
| Max. Negotiated Rate |
$4,472.40 |
| Rate for Payer: Aetna Commercial |
$3,587.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,633.82
|
| Rate for Payer: Cash Price |
$2,329.38
|
| Rate for Payer: Cigna Commercial |
$3,866.76
|
| Rate for Payer: First Health Commercial |
$4,425.81
|
| Rate for Payer: Humana Commercial |
$3,959.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,820.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,438.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,397.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,099.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,494.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,727.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,053.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,214.54
|
| Rate for Payer: PHCS Commercial |
$4,472.40
|
| Rate for Payer: United Healthcare All Payer |
$4,099.70
|
|
|
AMK PRIMARY LOCKING PIN
|
Facility
|
OP
|
$4,658.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,397.62 |
| Max. Negotiated Rate |
$4,472.40 |
| Rate for Payer: Aetna Commercial |
$3,587.24
|
| Rate for Payer: Anthem Medicaid |
$1,602.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,633.82
|
| Rate for Payer: Cash Price |
$2,329.38
|
| Rate for Payer: Cigna Commercial |
$3,866.76
|
| Rate for Payer: First Health Commercial |
$4,425.81
|
| Rate for Payer: Humana Commercial |
$3,959.94
|
| Rate for Payer: Humana KY Medicaid |
$1,602.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,618.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,820.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,438.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,397.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,634.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,099.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,494.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,727.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,053.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,214.54
|
| Rate for Payer: PHCS Commercial |
$4,472.40
|
| Rate for Payer: United Healthcare All Payer |
$4,099.70
|
|
|
AML SM 10.5MM FEM STEM
|
Facility
|
IP
|
$22,842.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,852.75 |
| Max. Negotiated Rate |
$21,928.80 |
| Rate for Payer: Aetna Commercial |
$17,588.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,817.15
|
| Rate for Payer: Cash Price |
$11,421.25
|
| Rate for Payer: Cigna Commercial |
$18,959.28
|
| Rate for Payer: First Health Commercial |
$21,700.38
|
| Rate for Payer: Humana Commercial |
$19,416.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,730.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,857.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,852.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,101.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,131.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,274.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,872.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,761.33
|
| Rate for Payer: PHCS Commercial |
$21,928.80
|
| Rate for Payer: United Healthcare All Payer |
$20,101.40
|
|
|
AML SM 10.5MM FEM STEM
|
Facility
|
OP
|
$22,842.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,852.75 |
| Max. Negotiated Rate |
$21,928.80 |
| Rate for Payer: Aetna Commercial |
$17,588.72
|
| Rate for Payer: Anthem Medicaid |
$7,855.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,817.15
|
| Rate for Payer: Cash Price |
$11,421.25
|
| Rate for Payer: Cigna Commercial |
$18,959.28
|
| Rate for Payer: First Health Commercial |
$21,700.38
|
| Rate for Payer: Humana Commercial |
$19,416.12
|
| Rate for Payer: Humana KY Medicaid |
$7,855.54
|
| Rate for Payer: Kentucky WC Medicaid |
$7,935.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,730.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,857.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,852.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,013.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,101.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,131.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,274.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,872.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,761.33
|
| Rate for Payer: PHCS Commercial |
$21,928.80
|
| Rate for Payer: United Healthcare All Payer |
$20,101.40
|
|
|
AML SM 12.0MM FEM STEM
|
Facility
|
OP
|
$22,842.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,852.75 |
| Max. Negotiated Rate |
$21,928.80 |
| Rate for Payer: Aetna Commercial |
$17,588.72
|
| Rate for Payer: Anthem Medicaid |
$7,855.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,817.15
|
| Rate for Payer: Cash Price |
$11,421.25
|
| Rate for Payer: Cigna Commercial |
$18,959.28
|
| Rate for Payer: First Health Commercial |
$21,700.38
|
| Rate for Payer: Humana Commercial |
$19,416.12
|
| Rate for Payer: Humana KY Medicaid |
$7,855.54
|
| Rate for Payer: Kentucky WC Medicaid |
$7,935.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,730.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,857.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,852.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,013.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,101.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,131.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,274.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,872.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,761.33
|
| Rate for Payer: PHCS Commercial |
$21,928.80
|
| Rate for Payer: United Healthcare All Payer |
$20,101.40
|
|
|
AML SM 12.0MM FEM STEM
|
Facility
|
IP
|
$22,842.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,852.75 |
| Max. Negotiated Rate |
$21,928.80 |
| Rate for Payer: Aetna Commercial |
$17,588.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,817.15
|
| Rate for Payer: Cash Price |
$11,421.25
|
| Rate for Payer: Cigna Commercial |
$18,959.28
|
| Rate for Payer: First Health Commercial |
$21,700.38
|
| Rate for Payer: Humana Commercial |
$19,416.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,730.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,857.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,852.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,101.40
|
| Rate for Payer: Ohio Health Group HMO |
$17,131.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,274.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,872.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,761.33
|
| Rate for Payer: PHCS Commercial |
$21,928.80
|
| Rate for Payer: United Healthcare All Payer |
$20,101.40
|
|
|
AMMONIA
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
30000237
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$177.60 |
| Rate for Payer: Aetna Commercial |
$142.45
|
| Rate for Payer: Anthem Medicaid |
$14.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.57
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$153.55
|
| Rate for Payer: First Health Commercial |
$175.75
|
| Rate for Payer: Humana Commercial |
$157.25
|
| 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 |
$151.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.80
|
| Rate for Payer: Ohio Health Group HMO |
$138.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.65
|
| Rate for Payer: PHCS Commercial |
$177.60
|
| Rate for Payer: United Healthcare All Payer |
$162.80
|
|
|
AMMONIA
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
30000237
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$177.60 |
| Rate for Payer: Aetna Commercial |
$142.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.56
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$153.55
|
| Rate for Payer: First Health Commercial |
$175.75
|
| Rate for Payer: Humana Commercial |
$157.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.80
|
| Rate for Payer: Ohio Health Group HMO |
$138.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.65
|
| Rate for Payer: PHCS Commercial |
$177.60
|
| Rate for Payer: United Healthcare All Payer |
$162.80
|
|
|
AMNIOBAND ALLOGFT MATRI 2*2
|
Facility
|
OP
|
$5,668.44
|
|
|
Service Code
|
HCPCS Q4151
|
| Hospital Charge Code |
27000287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,700.53 |
| Max. Negotiated Rate |
$5,441.70 |
| Rate for Payer: Aetna Commercial |
$4,364.70
|
| Rate for Payer: Anthem Medicaid |
$1,949.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,421.38
|
| Rate for Payer: Cash Price |
$2,834.22
|
| Rate for Payer: Cigna Commercial |
$4,704.81
|
| Rate for Payer: First Health Commercial |
$5,385.02
|
| Rate for Payer: Humana Commercial |
$4,818.17
|
| Rate for Payer: Humana KY Medicaid |
$1,949.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,969.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,648.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,183.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,700.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,988.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,988.23
|
| Rate for Payer: Ohio Health Group HMO |
$4,251.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,534.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,931.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,911.22
|
| Rate for Payer: PHCS Commercial |
$5,441.70
|
| Rate for Payer: United Healthcare All Payer |
$4,988.23
|
|
|
AMNIOBAND ALLOGFT MATRI 2*2
|
Facility
|
IP
|
$5,668.44
|
|
|
Service Code
|
HCPCS Q4151
|
| Hospital Charge Code |
27000287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,700.53 |
| Max. Negotiated Rate |
$5,441.70 |
| Rate for Payer: Aetna Commercial |
$4,364.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,421.38
|
| Rate for Payer: Cash Price |
$2,834.22
|
| Rate for Payer: Cigna Commercial |
$4,704.81
|
| Rate for Payer: First Health Commercial |
$5,385.02
|
| Rate for Payer: Humana Commercial |
$4,818.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,648.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,183.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,700.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,988.23
|
| Rate for Payer: Ohio Health Group HMO |
$4,251.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,534.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,931.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,911.22
|
| Rate for Payer: PHCS Commercial |
$5,441.70
|
| Rate for Payer: United Healthcare All Payer |
$4,988.23
|
|
|
AMNIOBAND MEMBRANE 4CM X 4CM
|
Facility
|
OP
|
$15,511.10
|
|
|
Service Code
|
HCPCS Q4151
|
| Hospital Charge Code |
27000287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,653.33 |
| Max. Negotiated Rate |
$14,890.66 |
| Rate for Payer: Aetna Commercial |
$11,943.55
|
| Rate for Payer: Anthem Medicaid |
$5,334.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,098.66
|
| Rate for Payer: Cash Price |
$7,755.55
|
| Rate for Payer: Cigna Commercial |
$12,874.21
|
| Rate for Payer: First Health Commercial |
$14,735.55
|
| Rate for Payer: Humana Commercial |
$13,184.43
|
| Rate for Payer: Humana KY Medicaid |
$5,334.27
|
| Rate for Payer: Kentucky WC Medicaid |
$5,388.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,719.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,447.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,653.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,441.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,649.77
|
| Rate for Payer: Ohio Health Group HMO |
$11,633.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,408.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,494.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,702.66
|
| Rate for Payer: PHCS Commercial |
$14,890.66
|
| Rate for Payer: United Healthcare All Payer |
$13,649.77
|
|
|
AMNIOBAND MEMBRANE 4CM X 4CM
|
Facility
|
IP
|
$15,511.10
|
|
|
Service Code
|
HCPCS Q4151
|
| Hospital Charge Code |
27000287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,653.33 |
| Max. Negotiated Rate |
$14,890.66 |
| Rate for Payer: Aetna Commercial |
$11,943.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,098.66
|
| Rate for Payer: Cash Price |
$7,755.55
|
| Rate for Payer: Cigna Commercial |
$12,874.21
|
| Rate for Payer: First Health Commercial |
$14,735.55
|
| Rate for Payer: Humana Commercial |
$13,184.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,719.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,447.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,653.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,649.77
|
| Rate for Payer: Ohio Health Group HMO |
$11,633.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,408.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,494.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,702.66
|
| Rate for Payer: PHCS Commercial |
$14,890.66
|
| Rate for Payer: United Healthcare All Payer |
$13,649.77
|
|
|
AMNIOBAND MEMBRANE 5CM X 6CM
|
Facility
|
OP
|
$26,157.50
|
|
|
Service Code
|
HCPCS Q4151
|
| Hospital Charge Code |
27000287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,847.25 |
| Max. Negotiated Rate |
$25,111.20 |
| Rate for Payer: Aetna Commercial |
$20,141.28
|
| Rate for Payer: Anthem Medicaid |
$8,995.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,402.85
|
| Rate for Payer: Cash Price |
$13,078.75
|
| Rate for Payer: Cigna Commercial |
$21,710.72
|
| Rate for Payer: First Health Commercial |
$24,849.62
|
| Rate for Payer: Humana Commercial |
$22,233.88
|
| Rate for Payer: Humana KY Medicaid |
$8,995.56
|
| Rate for Payer: Kentucky WC Medicaid |
$9,087.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,449.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,304.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,847.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,176.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$19,618.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,757.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,048.67
|
| Rate for Payer: PHCS Commercial |
$25,111.20
|
| Rate for Payer: United Healthcare All Payer |
$23,018.60
|
|
|
AMNIOBAND MEMBRANE 5CM X 6CM
|
Facility
|
IP
|
$26,157.50
|
|
|
Service Code
|
HCPCS Q4151
|
| Hospital Charge Code |
27000287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,847.25 |
| Max. Negotiated Rate |
$25,111.20 |
| Rate for Payer: Aetna Commercial |
$20,141.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,402.85
|
| Rate for Payer: Cash Price |
$13,078.75
|
| Rate for Payer: Cigna Commercial |
$21,710.72
|
| Rate for Payer: First Health Commercial |
$24,849.62
|
| Rate for Payer: Humana Commercial |
$22,233.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,449.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,304.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,847.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$19,618.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,757.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,048.67
|
| Rate for Payer: PHCS Commercial |
$25,111.20
|
| Rate for Payer: United Healthcare All Payer |
$23,018.60
|
|
|
AMNIOBAND MEMBRANE 7CM X 7CM
|
Facility
|
IP
|
$39,125.00
|
|
|
Service Code
|
HCPCS Q4151
|
| Hospital Charge Code |
27000287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,737.50 |
| Max. Negotiated Rate |
$37,560.00 |
| Rate for Payer: Aetna Commercial |
$30,126.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,517.50
|
| Rate for Payer: Cash Price |
$19,562.50
|
| Rate for Payer: Cigna Commercial |
$32,473.75
|
| Rate for Payer: First Health Commercial |
$37,168.75
|
| Rate for Payer: Humana Commercial |
$33,256.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,082.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,874.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,737.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,430.00
|
| Rate for Payer: Ohio Health Group HMO |
$29,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,038.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,996.25
|
| Rate for Payer: PHCS Commercial |
$37,560.00
|
| Rate for Payer: United Healthcare All Payer |
$34,430.00
|
|
|
AMNIOBAND MEMBRANE 7CM X 7CM
|
Facility
|
OP
|
$39,125.00
|
|
|
Service Code
|
HCPCS Q4151
|
| Hospital Charge Code |
27000287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,737.50 |
| Max. Negotiated Rate |
$37,560.00 |
| Rate for Payer: Aetna Commercial |
$30,126.25
|
| Rate for Payer: Anthem Medicaid |
$13,455.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,517.50
|
| Rate for Payer: Cash Price |
$19,562.50
|
| Rate for Payer: Cigna Commercial |
$32,473.75
|
| Rate for Payer: First Health Commercial |
$37,168.75
|
| Rate for Payer: Humana Commercial |
$33,256.25
|
| Rate for Payer: Humana KY Medicaid |
$13,455.09
|
| Rate for Payer: Kentucky WC Medicaid |
$13,592.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,082.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,874.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,737.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,725.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,430.00
|
| Rate for Payer: Ohio Health Group HMO |
$29,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,038.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,996.25
|
| Rate for Payer: PHCS Commercial |
$37,560.00
|
| Rate for Payer: United Healthcare All Payer |
$34,430.00
|
|
|
AMNIOCENTESIS
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS 59000
|
| Hospital Charge Code |
76102268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.02 |
| Max. Negotiated Rate |
$1,126.37 |
| Rate for Payer: Aetna Commercial |
$729.96
|
| Rate for Payer: Anthem Medicaid |
$326.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$804.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$739.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,126.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,086.14
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$786.84
|
| Rate for Payer: First Health Commercial |
$900.60
|
| Rate for Payer: Humana Commercial |
$805.80
|
| Rate for Payer: Humana KY Medicaid |
$326.02
|
| Rate for Payer: Humana Medicare Advantage |
$804.55
|
| Rate for Payer: Kentucky WC Medicaid |
$329.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$777.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$699.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$332.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$834.24
|
| Rate for Payer: Ohio Health Group HMO |
$711.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$758.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$824.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.12
|
| Rate for Payer: PHCS Commercial |
$910.08
|
| Rate for Payer: United Healthcare All Payer |
$834.24
|
|
|
AMNIOCENTESIS
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS 59000
|
| Hospital Charge Code |
76102268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.40 |
| Max. Negotiated Rate |
$910.08 |
| Rate for Payer: Aetna Commercial |
$729.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$739.44
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$786.84
|
| Rate for Payer: First Health Commercial |
$900.60
|
| Rate for Payer: Humana Commercial |
$805.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$777.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$699.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$284.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$834.24
|
| Rate for Payer: Ohio Health Group HMO |
$711.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$758.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$824.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.12
|
| Rate for Payer: PHCS Commercial |
$910.08
|
| Rate for Payer: United Healthcare All Payer |
$834.24
|
|
