|
FEMUR RESURFACING AX PIN SZ 1
|
Facility
|
IP
|
$13,720.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,116.28 |
| Max. Negotiated Rate |
$13,172.11 |
| Rate for Payer: Aetna Commercial |
$10,565.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,702.34
|
| Rate for Payer: Cash Price |
$6,860.48
|
| Rate for Payer: Cigna Commercial |
$11,388.39
|
| Rate for Payer: First Health Commercial |
$13,034.90
|
| Rate for Payer: Humana Commercial |
$11,662.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,251.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,126.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,116.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,074.44
|
| Rate for Payer: Ohio Health Group HMO |
$10,290.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,976.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,937.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,467.46
|
| Rate for Payer: PHCS Commercial |
$13,172.11
|
| Rate for Payer: United Healthcare All Payer |
$12,074.44
|
|
|
FEMUR RESURF AXIAL PIN SZ 3
|
Facility
|
OP
|
$17,298.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,189.46 |
| Max. Negotiated Rate |
$16,606.27 |
| Rate for Payer: Aetna Commercial |
$13,319.61
|
| Rate for Payer: Anthem Medicaid |
$5,948.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,492.60
|
| Rate for Payer: Cash Price |
$8,649.10
|
| Rate for Payer: Cigna Commercial |
$14,357.51
|
| Rate for Payer: First Health Commercial |
$16,433.29
|
| Rate for Payer: Humana Commercial |
$14,703.47
|
| Rate for Payer: Humana KY Medicaid |
$5,948.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,009.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,184.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,189.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,068.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,222.42
|
| Rate for Payer: Ohio Health Group HMO |
$12,973.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,838.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,049.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,935.76
|
| Rate for Payer: PHCS Commercial |
$16,606.27
|
| Rate for Payer: United Healthcare All Payer |
$15,222.42
|
|
|
FEMUR RESURF AXIAL PIN SZ 3
|
Facility
|
IP
|
$17,298.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,189.46 |
| Max. Negotiated Rate |
$16,606.27 |
| Rate for Payer: Aetna Commercial |
$13,319.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,492.60
|
| Rate for Payer: Cash Price |
$8,649.10
|
| Rate for Payer: Cigna Commercial |
$14,357.51
|
| Rate for Payer: First Health Commercial |
$16,433.29
|
| Rate for Payer: Humana Commercial |
$14,703.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,184.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,189.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,222.42
|
| Rate for Payer: Ohio Health Group HMO |
$12,973.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,838.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,049.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,935.76
|
| Rate for Payer: PHCS Commercial |
$16,606.27
|
| Rate for Payer: United Healthcare All Payer |
$15,222.42
|
|
|
FEMUR SEGMENTAL DIST XT SZ B L
|
Facility
|
OP
|
$37,383.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,214.94 |
| Max. Negotiated Rate |
$35,887.80 |
| Rate for Payer: Aetna Commercial |
$28,785.00
|
| Rate for Payer: Anthem Medicaid |
$12,856.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,158.83
|
| Rate for Payer: Cash Price |
$18,691.56
|
| Rate for Payer: Cigna Commercial |
$31,027.99
|
| Rate for Payer: First Health Commercial |
$35,513.96
|
| Rate for Payer: Humana Commercial |
$31,775.65
|
| Rate for Payer: Humana KY Medicaid |
$12,856.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12,986.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,654.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,588.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,214.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,114.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,897.15
|
| Rate for Payer: Ohio Health Group HMO |
$28,037.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,906.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,523.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,794.35
|
| Rate for Payer: PHCS Commercial |
$35,887.80
|
| Rate for Payer: United Healthcare All Payer |
$32,897.15
|
|
|
FEMUR SEGMENTAL DIST XT SZ B L
|
Facility
|
IP
|
$37,383.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,214.94 |
| Max. Negotiated Rate |
$35,887.80 |
| Rate for Payer: Aetna Commercial |
$28,785.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,158.83
|
| Rate for Payer: Cash Price |
$18,691.56
|
| Rate for Payer: Cigna Commercial |
$31,027.99
|
| Rate for Payer: First Health Commercial |
$35,513.96
|
| Rate for Payer: Humana Commercial |
$31,775.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,654.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,588.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,214.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,897.15
|
| Rate for Payer: Ohio Health Group HMO |
$28,037.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,906.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,523.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,794.35
|
| Rate for Payer: PHCS Commercial |
$35,887.80
|
| Rate for Payer: United Healthcare All Payer |
$32,897.15
|
|
|
FEMUR SEGMENTAL DIST XT SZ B R
|
Facility
|
IP
|
$37,383.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,214.94 |
| Max. Negotiated Rate |
$35,887.80 |
| Rate for Payer: Aetna Commercial |
$28,785.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,158.83
|
| Rate for Payer: Cash Price |
$18,691.56
|
| Rate for Payer: Cigna Commercial |
$31,027.99
|
| Rate for Payer: First Health Commercial |
$35,513.96
|
| Rate for Payer: Humana Commercial |
$31,775.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,654.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,588.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,214.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,897.15
|
| Rate for Payer: Ohio Health Group HMO |
$28,037.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,906.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,523.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,794.35
|
| Rate for Payer: PHCS Commercial |
$35,887.80
|
| Rate for Payer: United Healthcare All Payer |
$32,897.15
|
|
|
FEMUR SEGMENTAL DIST XT SZ B R
|
Facility
|
OP
|
$37,383.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,214.94 |
| Max. Negotiated Rate |
$35,887.80 |
| Rate for Payer: Aetna Commercial |
$28,785.00
|
| Rate for Payer: Anthem Medicaid |
$12,856.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,158.83
|
| Rate for Payer: Cash Price |
$18,691.56
|
| Rate for Payer: Cigna Commercial |
$31,027.99
|
| Rate for Payer: First Health Commercial |
$35,513.96
|
| Rate for Payer: Humana Commercial |
$31,775.65
|
| Rate for Payer: Humana KY Medicaid |
$12,856.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12,986.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,654.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,588.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,214.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,114.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,897.15
|
| Rate for Payer: Ohio Health Group HMO |
$28,037.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,906.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,523.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,794.35
|
| Rate for Payer: PHCS Commercial |
$35,887.80
|
| Rate for Payer: United Healthcare All Payer |
$32,897.15
|
|
|
FEMUR SEGMENTAL DIST XT SZ C L
|
Facility
|
IP
|
$37,383.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,214.94 |
| Max. Negotiated Rate |
$35,887.80 |
| Rate for Payer: Aetna Commercial |
$28,785.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,158.83
|
| Rate for Payer: Cash Price |
$18,691.56
|
| Rate for Payer: Cigna Commercial |
$31,027.99
|
| Rate for Payer: First Health Commercial |
$35,513.96
|
| Rate for Payer: Humana Commercial |
$31,775.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,654.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,588.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,214.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,897.15
|
| Rate for Payer: Ohio Health Group HMO |
$28,037.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,906.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,523.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,794.35
|
| Rate for Payer: PHCS Commercial |
$35,887.80
|
| Rate for Payer: United Healthcare All Payer |
$32,897.15
|
|
|
FEMUR SEGMENTAL DIST XT SZ C L
|
Facility
|
OP
|
$37,383.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,214.94 |
| Max. Negotiated Rate |
$35,887.80 |
| Rate for Payer: Aetna Commercial |
$28,785.00
|
| Rate for Payer: Anthem Medicaid |
$12,856.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,158.83
|
| Rate for Payer: Cash Price |
$18,691.56
|
| Rate for Payer: Cigna Commercial |
$31,027.99
|
| Rate for Payer: First Health Commercial |
$35,513.96
|
| Rate for Payer: Humana Commercial |
$31,775.65
|
| Rate for Payer: Humana KY Medicaid |
$12,856.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12,986.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,654.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,588.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,214.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,114.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,897.15
|
| Rate for Payer: Ohio Health Group HMO |
$28,037.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,906.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,523.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,794.35
|
| Rate for Payer: PHCS Commercial |
$35,887.80
|
| Rate for Payer: United Healthcare All Payer |
$32,897.15
|
|
|
FEMUR SEGMENTAL DIST XT SZ C R
|
Facility
|
IP
|
$37,383.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,214.94 |
| Max. Negotiated Rate |
$35,887.80 |
| Rate for Payer: Aetna Commercial |
$28,785.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,158.83
|
| Rate for Payer: Cash Price |
$18,691.56
|
| Rate for Payer: Cigna Commercial |
$31,027.99
|
| Rate for Payer: First Health Commercial |
$35,513.96
|
| Rate for Payer: Humana Commercial |
$31,775.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,654.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,588.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,214.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,897.15
|
| Rate for Payer: Ohio Health Group HMO |
$28,037.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,906.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,523.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,794.35
|
| Rate for Payer: PHCS Commercial |
$35,887.80
|
| Rate for Payer: United Healthcare All Payer |
$32,897.15
|
|
|
FEMUR SEGMENTAL DIST XT SZ C R
|
Facility
|
OP
|
$37,383.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,214.94 |
| Max. Negotiated Rate |
$35,887.80 |
| Rate for Payer: Aetna Commercial |
$28,785.00
|
| Rate for Payer: Anthem Medicaid |
$12,856.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,158.83
|
| Rate for Payer: Cash Price |
$18,691.56
|
| Rate for Payer: Cigna Commercial |
$31,027.99
|
| Rate for Payer: First Health Commercial |
$35,513.96
|
| Rate for Payer: Humana Commercial |
$31,775.65
|
| Rate for Payer: Humana KY Medicaid |
$12,856.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12,986.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,654.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,588.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,214.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,114.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,897.15
|
| Rate for Payer: Ohio Health Group HMO |
$28,037.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,906.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,523.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,794.35
|
| Rate for Payer: PHCS Commercial |
$35,887.80
|
| Rate for Payer: United Healthcare All Payer |
$32,897.15
|
|
|
FEOSOL(FERROUS SULF 324MG/1TAB
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 904759080
|
| Hospital Charge Code |
25000673
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
FEOSOL(FERROUS SULF 324MG/1TAB
|
Facility
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 904759080
|
| Hospital Charge Code |
25000673
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
FERAHEME 1 MG [510MG/17ML VL]
|
Facility
|
IP
|
$2,943.62
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
25002700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$883.09 |
| Max. Negotiated Rate |
$2,825.88 |
| Rate for Payer: Aetna Commercial |
$2,266.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,296.02
|
| Rate for Payer: Cash Price |
$1,471.81
|
| Rate for Payer: Cigna Commercial |
$2,443.20
|
| Rate for Payer: First Health Commercial |
$2,796.44
|
| Rate for Payer: Humana Commercial |
$2,502.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,413.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,172.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$883.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,590.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,207.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,354.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,560.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,031.10
|
| Rate for Payer: PHCS Commercial |
$2,825.88
|
| Rate for Payer: United Healthcare All Payer |
$2,590.39
|
|
|
FERAHEME 1 MG [510MG/17ML VL]
|
Facility
|
OP
|
$2,943.62
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
25002700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$2,825.88 |
| Rate for Payer: Aetna Commercial |
$2,266.59
|
| Rate for Payer: Anthem Medicaid |
$1,012.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,296.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.42
|
| Rate for Payer: Cash Price |
$1,471.81
|
| Rate for Payer: Cash Price |
$1,471.81
|
| Rate for Payer: Cigna Commercial |
$2,443.20
|
| Rate for Payer: First Health Commercial |
$2,796.44
|
| Rate for Payer: Humana Commercial |
$2,502.08
|
| Rate for Payer: Humana KY Medicaid |
$1,012.31
|
| Rate for Payer: Humana Medicare Advantage |
$0.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,022.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,413.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,172.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,032.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,590.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,207.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,354.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,560.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,031.10
|
| Rate for Payer: PHCS Commercial |
$2,825.88
|
| Rate for Payer: United Healthcare All Payer |
$2,590.39
|
|
|
FERRIC SUBSULFATE (100mL)
|
Facility
|
IP
|
$197.71
|
|
|
Service Code
|
NDC 38779128405
|
| Hospital Charge Code |
25004161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.31 |
| Max. Negotiated Rate |
$189.80 |
| Rate for Payer: Aetna Commercial |
$152.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.21
|
| Rate for Payer: Cash Price |
$98.86
|
| Rate for Payer: Cigna Commercial |
$164.10
|
| Rate for Payer: First Health Commercial |
$187.82
|
| Rate for Payer: Humana Commercial |
$168.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.98
|
| Rate for Payer: Ohio Health Group HMO |
$148.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.42
|
| Rate for Payer: PHCS Commercial |
$189.80
|
| Rate for Payer: United Healthcare All Payer |
$173.98
|
|
|
FERRIC SUBSULFATE (100mL)
|
Facility
|
OP
|
$197.71
|
|
|
Service Code
|
NDC 38779128405
|
| Hospital Charge Code |
25004161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.31 |
| Max. Negotiated Rate |
$189.80 |
| Rate for Payer: Aetna Commercial |
$152.24
|
| Rate for Payer: Anthem Medicaid |
$67.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.21
|
| Rate for Payer: Cash Price |
$98.86
|
| Rate for Payer: Cigna Commercial |
$164.10
|
| Rate for Payer: First Health Commercial |
$187.82
|
| Rate for Payer: Humana Commercial |
$168.05
|
| Rate for Payer: Humana KY Medicaid |
$67.99
|
| Rate for Payer: Kentucky WC Medicaid |
$68.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.98
|
| Rate for Payer: Ohio Health Group HMO |
$148.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.42
|
| Rate for Payer: PHCS Commercial |
$189.80
|
| Rate for Payer: United Healthcare All Payer |
$173.98
|
|
|
FERRITIN
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
30000319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Ambetter Exchange |
$13.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.36
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$11.98
|
| Rate for Payer: Healthspan PPO |
$14.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.63
|
| Rate for Payer: Multiplan PHCS |
$77.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.72
|
| Rate for Payer: UHCCP Medicaid |
$45.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.63
|
|
|
FERRITIN
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
30000319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$13.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.63
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$13.63
|
| Rate for Payer: Humana Medicare Advantage |
$13.63
|
| Rate for Payer: Kentucky WC Medicaid |
$13.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
FERRITIN
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
30000319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
FERRLECIT 12.5MG[62.5MG/5ML]
|
Facility
|
OP
|
$187.80
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
25002359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.34 |
| Max. Negotiated Rate |
$180.29 |
| Rate for Payer: Aetna Commercial |
$144.61
|
| Rate for Payer: Anthem Medicaid |
$64.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.48
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$155.87
|
| Rate for Payer: First Health Commercial |
$178.41
|
| Rate for Payer: Humana Commercial |
$159.63
|
| Rate for Payer: Humana KY Medicaid |
$64.58
|
| Rate for Payer: Kentucky WC Medicaid |
$65.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.26
|
| Rate for Payer: Ohio Health Group HMO |
$140.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.58
|
| Rate for Payer: PHCS Commercial |
$180.29
|
| Rate for Payer: United Healthcare All Payer |
$165.26
|
|
|
FERRLECIT 12.5MG[62.5MG/5ML]
|
Facility
|
IP
|
$187.80
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
25002359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.34 |
| Max. Negotiated Rate |
$180.29 |
| Rate for Payer: Aetna Commercial |
$144.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.48
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$155.87
|
| Rate for Payer: First Health Commercial |
$178.41
|
| Rate for Payer: Humana Commercial |
$159.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.26
|
| Rate for Payer: Ohio Health Group HMO |
$140.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.58
|
| Rate for Payer: PHCS Commercial |
$180.29
|
| Rate for Payer: United Healthcare All Payer |
$165.26
|
|
|
FERROUS GLUCONATE 3 325MG/1TAB
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 54629064501
|
| Hospital Charge Code |
25000674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
FERROUS GLUCONATE 3 325MG/1TAB
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 54629064501
|
| Hospital Charge Code |
25000674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
FERROUS SULFATE 300 300MG/5ML
|
Facility
|
OP
|
$11.39
|
|
|
Service Code
|
NDC 121053005
|
| Hospital Charge Code |
25000675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$10.93 |
| Rate for Payer: Aetna Commercial |
$8.77
|
| Rate for Payer: Anthem Medicaid |
$3.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.88
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$9.45
|
| Rate for Payer: First Health Commercial |
$10.82
|
| Rate for Payer: Humana Commercial |
$9.68
|
| Rate for Payer: Humana KY Medicaid |
$3.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.02
|
| Rate for Payer: Ohio Health Group HMO |
$8.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.86
|
| Rate for Payer: PHCS Commercial |
$10.93
|
| Rate for Payer: United Healthcare All Payer |
$10.02
|
|
