|
FLOMAX (TAMSULOSIN)0.4MG CAP
|
Facility
|
OP
|
$4.79
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
25000684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.55
|
| Rate for Payer: Humana Commercial |
$4.07
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| Rate for Payer: PHCS Commercial |
$4.60
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
FLOMAX (TAMSULOSIN)0.4MG CAP
|
Facility
|
IP
|
$4.79
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
25000684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$3.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.55
|
| Rate for Payer: Humana Commercial |
$4.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| Rate for Payer: PHCS Commercial |
$4.60
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
FLONASE (FLUTICASONE .05%/16GM
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
25000685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.61
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna Commercial |
$0.65
|
| Rate for Payer: First Health Commercial |
$0.74
|
| Rate for Payer: Humana Commercial |
$0.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.69
|
| Rate for Payer: Ohio Health Group HMO |
$0.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.54
|
| Rate for Payer: PHCS Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Payer |
$0.69
|
|
|
FLONASE (FLUTICASONE .05%/16GM
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
NDC 60505082901
|
| Hospital Charge Code |
25000685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Anthem Medicaid |
$0.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.61
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna Commercial |
$0.65
|
| Rate for Payer: First Health Commercial |
$0.74
|
| Rate for Payer: Humana Commercial |
$0.66
|
| Rate for Payer: Humana KY Medicaid |
$0.27
|
| Rate for Payer: Kentucky WC Medicaid |
$0.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.69
|
| Rate for Payer: Ohio Health Group HMO |
$0.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.54
|
| Rate for Payer: PHCS Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Payer |
$0.69
|
|
|
FLORINEF(FLUDROCORTI .1MG/1TAB
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
25000687
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
FLORINEF(FLUDROCORTI .1MG/1TAB
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 68084028801
|
| Hospital Charge Code |
25000687
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
FLOSEAL HEMO SEALANT 10ML
|
Facility
|
IP
|
$3,290.42
|
|
| Hospital Charge Code |
25003071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$987.13 |
| Max. Negotiated Rate |
$3,158.80 |
| Rate for Payer: Aetna Commercial |
$2,533.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.53
|
| Rate for Payer: Cash Price |
$1,645.21
|
| Rate for Payer: Cigna Commercial |
$2,731.05
|
| Rate for Payer: First Health Commercial |
$3,125.90
|
| Rate for Payer: Humana Commercial |
$2,796.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,698.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.39
|
| Rate for Payer: PHCS Commercial |
$3,158.80
|
| Rate for Payer: United Healthcare All Payer |
$2,895.57
|
|
|
FLOSEAL HEMO SEALANT 10ML
|
Facility
|
OP
|
$3,290.42
|
|
| Hospital Charge Code |
25003071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$987.13 |
| Max. Negotiated Rate |
$3,158.80 |
| Rate for Payer: Aetna Commercial |
$2,533.62
|
| Rate for Payer: Anthem Medicaid |
$1,131.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.53
|
| Rate for Payer: Cash Price |
$1,645.21
|
| Rate for Payer: Cigna Commercial |
$2,731.05
|
| Rate for Payer: First Health Commercial |
$3,125.90
|
| Rate for Payer: Humana Commercial |
$2,796.86
|
| Rate for Payer: Humana KY Medicaid |
$1,131.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,143.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,698.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,154.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.39
|
| Rate for Payer: PHCS Commercial |
$3,158.80
|
| Rate for Payer: United Healthcare All Payer |
$2,895.57
|
|
|
FLOSEAL HEMOSTATIC MATRIX 5ML
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
25003071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FLOSEAL HEMOSTATIC MATRIX 5ML
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
25003071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FLOVENT HFA 110 MCG INH 12 GM
|
Facility
|
OP
|
$4.97
|
|
|
Service Code
|
NDC 66993007996
|
| Hospital Charge Code |
25000688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Anthem Medicaid |
$1.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.88
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.13
|
| Rate for Payer: First Health Commercial |
$4.72
|
| Rate for Payer: Humana Commercial |
$4.22
|
| Rate for Payer: Humana KY Medicaid |
$1.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.37
|
| Rate for Payer: Ohio Health Group HMO |
$3.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.43
|
| Rate for Payer: PHCS Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Payer |
$4.37
|
|
|
FLOVENT HFA 110 MCG INH 12 GM
|
Facility
|
IP
|
$4.97
|
|
|
Service Code
|
NDC 66993007996
|
| Hospital Charge Code |
25000688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.88
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.13
|
| Rate for Payer: First Health Commercial |
$4.72
|
| Rate for Payer: Humana Commercial |
$4.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.37
|
| Rate for Payer: Ohio Health Group HMO |
$3.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.43
|
| Rate for Payer: PHCS Commercial |
$4.77
|
| Rate for Payer: United Healthcare All Payer |
$4.37
|
|
|
FLOVENT HFA 220 MCG INH 12 GM
|
Facility
|
OP
|
$7.35
|
|
|
Service Code
|
NDC 66993008096
|
| Hospital Charge Code |
25000689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$5.66
|
| Rate for Payer: Anthem Medicaid |
$2.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.73
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cigna Commercial |
$6.10
|
| Rate for Payer: First Health Commercial |
$6.98
|
| Rate for Payer: Humana Commercial |
$6.25
|
| Rate for Payer: Humana KY Medicaid |
$2.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.47
|
| Rate for Payer: Ohio Health Group HMO |
$5.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.07
|
| Rate for Payer: PHCS Commercial |
$7.06
|
| Rate for Payer: United Healthcare All Payer |
$6.47
|
|
|
FLOVENT HFA 220 MCG INH 12 GM
|
Facility
|
IP
|
$7.35
|
|
|
Service Code
|
NDC 66993008096
|
| Hospital Charge Code |
25000689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$7.06 |
| Rate for Payer: Aetna Commercial |
$5.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.73
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cigna Commercial |
$6.10
|
| Rate for Payer: First Health Commercial |
$6.98
|
| Rate for Payer: Humana Commercial |
$6.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.47
|
| Rate for Payer: Ohio Health Group HMO |
$5.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.07
|
| Rate for Payer: PHCS Commercial |
$7.06
|
| Rate for Payer: United Healthcare All Payer |
$6.47
|
|
|
FLOVENT HFA 44MCG INH 10.6GRAM
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 66993007896
|
| Hospital Charge Code |
25000691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
|
|
FLOVENT HFA 44MCG INH 10.6GRAM
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 66993007896
|
| Hospital Charge Code |
25000691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
|
|
FLOW CYTOMETRY 1ST MARKER WBC
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 88184
|
| Hospital Charge Code |
30001431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$465.32 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem Medicaid |
$332.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$168.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$332.37
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Humana KY Medicaid |
$332.37
|
| Rate for Payer: Humana Medicare Advantage |
$332.37
|
| Rate for Payer: Kentucky WC Medicaid |
$335.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
FLOW CYTOMETRY 1ST MARKER WBC
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 88184
|
| Hospital Charge Code |
30001431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$168.63
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
FLOW DIRECTD BI-POLR PACING CA
|
Facility
|
IP
|
$1,843.40
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.02 |
| Max. Negotiated Rate |
$1,769.66 |
| Rate for Payer: Aetna Commercial |
$1,419.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,437.85
|
| Rate for Payer: Cash Price |
$921.70
|
| Rate for Payer: Cigna Commercial |
$1,530.02
|
| Rate for Payer: First Health Commercial |
$1,751.23
|
| Rate for Payer: Humana Commercial |
$1,566.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,511.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,382.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,474.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,603.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.95
|
| Rate for Payer: PHCS Commercial |
$1,769.66
|
| Rate for Payer: United Healthcare All Payer |
$1,622.19
|
|
|
FLOW DIRECTD BI-POLR PACING CA
|
Facility
|
OP
|
$1,843.40
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$553.02 |
| Max. Negotiated Rate |
$1,769.66 |
| Rate for Payer: Aetna Commercial |
$1,419.42
|
| Rate for Payer: Anthem Medicaid |
$633.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,437.85
|
| Rate for Payer: Cash Price |
$921.70
|
| Rate for Payer: Cigna Commercial |
$1,530.02
|
| Rate for Payer: First Health Commercial |
$1,751.23
|
| Rate for Payer: Humana Commercial |
$1,566.89
|
| Rate for Payer: Humana KY Medicaid |
$633.95
|
| Rate for Payer: Kentucky WC Medicaid |
$640.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,511.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$646.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,382.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,474.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,603.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.95
|
| Rate for Payer: PHCS Commercial |
$1,769.66
|
| Rate for Payer: United Healthcare All Payer |
$1,622.19
|
|
|
FLOW RESERVE MEASURE - INITIA
|
Facility
|
OP
|
$1,813.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
76102492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem Medicaid |
$623.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Humana KY Medicaid |
$623.49
|
| Rate for Payer: Kentucky WC Medicaid |
$629.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
FLOW RESERVE MEASURE - INITIA
|
Professional
|
Both
|
$1,813.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
76102492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$1,269.10 |
| Rate for Payer: Aetna Commercial |
$455.59
|
| Rate for Payer: Anthem Medicaid |
$198.80
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$427.67
|
| Rate for Payer: Healthspan PPO |
$418.89
|
| Rate for Payer: Humana Medicaid |
$198.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$126.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$202.78
|
| Rate for Payer: Molina Healthcare Passport |
$198.80
|
| Rate for Payer: Multiplan PHCS |
$1,087.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,269.10
|
| Rate for Payer: UHCCP Medicaid |
$634.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$200.79
|
|
|
FLOW RESERVE MEASURE - INITIA
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$515.10 |
| Max. Negotiated Rate |
$1,648.32 |
| Rate for Payer: Aetna Commercial |
$1,322.09
|
| Rate for Payer: Anthem Medicaid |
$590.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.26
|
| Rate for Payer: Cash Price |
$858.50
|
| Rate for Payer: Cigna Commercial |
$1,425.11
|
| Rate for Payer: First Health Commercial |
$1,631.15
|
| Rate for Payer: Humana Commercial |
$1,459.45
|
| Rate for Payer: Humana KY Medicaid |
$590.48
|
| Rate for Payer: Kentucky WC Medicaid |
$596.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,407.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$602.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,510.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,287.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,373.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,493.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,184.73
|
| Rate for Payer: PHCS Commercial |
$1,648.32
|
| Rate for Payer: United Healthcare All Payer |
$1,510.96
|
|
|
FLOW RESERVE MEASURE - INITIA
|
Facility
|
IP
|
$1,813.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
76102492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
FLOW RESERVE MEASURE - INITIA
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
HCPCS 93571
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$515.10 |
| Max. Negotiated Rate |
$1,648.32 |
| Rate for Payer: Aetna Commercial |
$1,322.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.26
|
| Rate for Payer: Cash Price |
$858.50
|
| Rate for Payer: Cigna Commercial |
$1,425.11
|
| Rate for Payer: First Health Commercial |
$1,631.15
|
| Rate for Payer: Humana Commercial |
$1,459.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,407.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,510.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,287.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,373.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,493.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,184.73
|
| Rate for Payer: PHCS Commercial |
$1,648.32
|
| Rate for Payer: United Healthcare All Payer |
$1,510.96
|
|
