|
HYDROGENPEROX 1.5% ORL (30ML)
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 38341008016
|
| Hospital Charge Code |
25003105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.28
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
|
HYDROGEN PEROXIDE 3% SOL 473ML
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 46122033443
|
| Hospital Charge Code |
25000762
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: Humana Commercial |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.01
|
| Rate for Payer: Ohio Health Group HMO |
$0.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Payer |
$0.01
|
|
|
HYDROGEN PEROXIDE 3% SOL 473ML
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 46122033443
|
| Hospital Charge Code |
25000762
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Anthem Medicaid |
$0.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: Humana Commercial |
$0.01
|
| Rate for Payer: Humana KY Medicaid |
$0.00
|
| Rate for Payer: Kentucky WC Medicaid |
$0.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.01
|
| Rate for Payer: Ohio Health Group HMO |
$0.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Payer |
$0.01
|
|
|
HYDROMORPHONE 100mg/100mL DRIP
|
Facility
|
OP
|
$101.04
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
25004277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna Commercial |
$77.80
|
| Rate for Payer: Anthem Medicaid |
$34.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.81
|
| Rate for Payer: Cash Price |
$50.52
|
| Rate for Payer: Cigna Commercial |
$83.86
|
| Rate for Payer: First Health Commercial |
$95.99
|
| Rate for Payer: Humana Commercial |
$85.88
|
| Rate for Payer: Humana KY Medicaid |
$34.75
|
| Rate for Payer: Kentucky WC Medicaid |
$35.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.92
|
| Rate for Payer: Ohio Health Group HMO |
$75.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.72
|
| Rate for Payer: PHCS Commercial |
$97.00
|
| Rate for Payer: United Healthcare All Payer |
$88.92
|
|
|
HYDROMORPHONE 100mg/100mL DRIP
|
Facility
|
IP
|
$101.04
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
25004277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.31 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna Commercial |
$77.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.81
|
| Rate for Payer: Cash Price |
$50.52
|
| Rate for Payer: Cigna Commercial |
$83.86
|
| Rate for Payer: First Health Commercial |
$95.99
|
| Rate for Payer: Humana Commercial |
$85.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.92
|
| Rate for Payer: Ohio Health Group HMO |
$75.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.72
|
| Rate for Payer: PHCS Commercial |
$97.00
|
| Rate for Payer: United Healthcare All Payer |
$88.92
|
|
|
HYDROMORPHONE10MG/ML PFAMP(5ML
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
25002032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.76
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
HYDROMORPHONE10MG/ML PFAMP(5ML
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
25002032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$31.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.76
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$31.64
|
| Rate for Payer: Kentucky WC Medicaid |
$31.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.48
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
HYDROPHOR OINTMENT 100 GM
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 61924018404
|
| Hospital Charge Code |
25000764
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna Commercial |
$0.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna Commercial |
$0.08
|
| Rate for Payer: First Health Commercial |
$0.10
|
| Rate for Payer: Humana Commercial |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.09
|
| Rate for Payer: Ohio Health Group HMO |
$0.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.07
|
| Rate for Payer: PHCS Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Payer |
$0.09
|
|
|
HYDROPHOR OINTMENT 100 GM
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 61924018404
|
| Hospital Charge Code |
25000764
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna Commercial |
$0.08
|
| Rate for Payer: Anthem Medicaid |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna Commercial |
$0.08
|
| Rate for Payer: First Health Commercial |
$0.10
|
| Rate for Payer: Humana Commercial |
$0.09
|
| Rate for Payer: Humana KY Medicaid |
$0.03
|
| Rate for Payer: Kentucky WC Medicaid |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.09
|
| Rate for Payer: Ohio Health Group HMO |
$0.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.07
|
| Rate for Payer: PHCS Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Payer |
$0.09
|
|
|
HYDRO SET INJCTBONE SUB CEM 10
|
Facility
|
IP
|
$14,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,254.90 |
| Max. Negotiated Rate |
$13,615.68 |
| Rate for Payer: Aetna Commercial |
$10,920.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,062.74
|
| Rate for Payer: Cash Price |
$7,091.50
|
| Rate for Payer: Cigna Commercial |
$11,771.89
|
| Rate for Payer: First Health Commercial |
$13,473.85
|
| Rate for Payer: Humana Commercial |
$12,055.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,630.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,467.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,254.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,481.04
|
| Rate for Payer: Ohio Health Group HMO |
$10,637.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,346.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,339.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,786.27
|
| Rate for Payer: PHCS Commercial |
$13,615.68
|
| Rate for Payer: United Healthcare All Payer |
$12,481.04
|
|
|
HYDRO SET INJCTBONE SUB CEM 10
|
Facility
|
OP
|
$14,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,254.90 |
| Max. Negotiated Rate |
$13,615.68 |
| Rate for Payer: Aetna Commercial |
$10,920.91
|
| Rate for Payer: Anthem Medicaid |
$4,877.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,062.74
|
| Rate for Payer: Cash Price |
$7,091.50
|
| Rate for Payer: Cigna Commercial |
$11,771.89
|
| Rate for Payer: First Health Commercial |
$13,473.85
|
| Rate for Payer: Humana Commercial |
$12,055.55
|
| Rate for Payer: Humana KY Medicaid |
$4,877.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,927.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,630.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,467.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,254.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,975.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,481.04
|
| Rate for Payer: Ohio Health Group HMO |
$10,637.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,346.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,339.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,786.27
|
| Rate for Payer: PHCS Commercial |
$13,615.68
|
| Rate for Payer: United Healthcare All Payer |
$12,481.04
|
|
|
HYDRO SET INJCT BONE SUB CEM15
|
Facility
|
OP
|
$20,693.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,208.12 |
| Max. Negotiated Rate |
$19,866.00 |
| Rate for Payer: Aetna Commercial |
$15,934.19
|
| Rate for Payer: Anthem Medicaid |
$7,116.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,141.12
|
| Rate for Payer: Cash Price |
$10,346.88
|
| Rate for Payer: Cigna Commercial |
$17,175.81
|
| Rate for Payer: First Health Commercial |
$19,659.06
|
| Rate for Payer: Humana Commercial |
$17,589.69
|
| Rate for Payer: Humana KY Medicaid |
$7,116.58
|
| Rate for Payer: Kentucky WC Medicaid |
$7,189.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,968.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,271.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,208.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,259.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,210.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,520.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,555.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,003.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,278.69
|
| Rate for Payer: PHCS Commercial |
$19,866.00
|
| Rate for Payer: United Healthcare All Payer |
$18,210.50
|
|
|
HYDRO SET INJCT BONE SUB CEM15
|
Facility
|
IP
|
$20,693.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,208.12 |
| Max. Negotiated Rate |
$19,866.00 |
| Rate for Payer: Aetna Commercial |
$15,934.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,141.12
|
| Rate for Payer: Cash Price |
$10,346.88
|
| Rate for Payer: Cigna Commercial |
$17,175.81
|
| Rate for Payer: First Health Commercial |
$19,659.06
|
| Rate for Payer: Humana Commercial |
$17,589.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,968.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,271.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,208.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,210.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,520.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,555.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,003.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,278.69
|
| Rate for Payer: PHCS Commercial |
$19,866.00
|
| Rate for Payer: United Healthcare All Payer |
$18,210.50
|
|
|
HYDRO SET INJCT BONE SUB CEM 3
|
Facility
|
IP
|
$5,539.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,661.94 |
| Max. Negotiated Rate |
$5,318.22 |
| Rate for Payer: Aetna Commercial |
$4,265.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,321.05
|
| Rate for Payer: Cash Price |
$2,769.91
|
| Rate for Payer: Cigna Commercial |
$4,598.04
|
| Rate for Payer: First Health Commercial |
$5,262.82
|
| Rate for Payer: Humana Commercial |
$4,708.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,542.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,088.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,875.03
|
| Rate for Payer: Ohio Health Group HMO |
$4,154.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,431.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,819.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,822.47
|
| Rate for Payer: PHCS Commercial |
$5,318.22
|
| Rate for Payer: United Healthcare All Payer |
$4,875.03
|
|
|
HYDRO SET INJCT BONE SUB CEM 3
|
Facility
|
OP
|
$5,539.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,661.94 |
| Max. Negotiated Rate |
$5,318.22 |
| Rate for Payer: Aetna Commercial |
$4,265.65
|
| Rate for Payer: Anthem Medicaid |
$1,905.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,321.05
|
| Rate for Payer: Cash Price |
$2,769.91
|
| Rate for Payer: Cigna Commercial |
$4,598.04
|
| Rate for Payer: First Health Commercial |
$5,262.82
|
| Rate for Payer: Humana Commercial |
$4,708.84
|
| Rate for Payer: Humana KY Medicaid |
$1,905.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,924.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,542.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,088.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,943.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,875.03
|
| Rate for Payer: Ohio Health Group HMO |
$4,154.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,431.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,819.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,822.47
|
| Rate for Payer: PHCS Commercial |
$5,318.22
|
| Rate for Payer: United Healthcare All Payer |
$4,875.03
|
|
|
HYDROSET XT INJ BNE SUB CEM 10
|
Facility
|
IP
|
$14,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,254.90 |
| Max. Negotiated Rate |
$13,615.68 |
| Rate for Payer: Aetna Commercial |
$10,920.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,062.74
|
| Rate for Payer: Cash Price |
$7,091.50
|
| Rate for Payer: Cigna Commercial |
$11,771.89
|
| Rate for Payer: First Health Commercial |
$13,473.85
|
| Rate for Payer: Humana Commercial |
$12,055.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,630.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,467.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,254.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,481.04
|
| Rate for Payer: Ohio Health Group HMO |
$10,637.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,346.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,339.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,786.27
|
| Rate for Payer: PHCS Commercial |
$13,615.68
|
| Rate for Payer: United Healthcare All Payer |
$12,481.04
|
|
|
HYDROSET XT INJ BNE SUB CEM 10
|
Facility
|
OP
|
$14,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,254.90 |
| Max. Negotiated Rate |
$13,615.68 |
| Rate for Payer: Aetna Commercial |
$10,920.91
|
| Rate for Payer: Anthem Medicaid |
$4,877.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,062.74
|
| Rate for Payer: Cash Price |
$7,091.50
|
| Rate for Payer: Cigna Commercial |
$11,771.89
|
| Rate for Payer: First Health Commercial |
$13,473.85
|
| Rate for Payer: Humana Commercial |
$12,055.55
|
| Rate for Payer: Humana KY Medicaid |
$4,877.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,927.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,630.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,467.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,254.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,975.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,481.04
|
| Rate for Payer: Ohio Health Group HMO |
$10,637.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,346.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,339.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,786.27
|
| Rate for Payer: PHCS Commercial |
$13,615.68
|
| Rate for Payer: United Healthcare All Payer |
$12,481.04
|
|
|
HYDROSET XT INJ BNESUB CEM15CC
|
Facility
|
IP
|
$20,693.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,208.12 |
| Max. Negotiated Rate |
$19,866.00 |
| Rate for Payer: Aetna Commercial |
$15,934.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,141.12
|
| Rate for Payer: Cash Price |
$10,346.88
|
| Rate for Payer: Cigna Commercial |
$17,175.81
|
| Rate for Payer: First Health Commercial |
$19,659.06
|
| Rate for Payer: Humana Commercial |
$17,589.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,968.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,271.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,208.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,210.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,520.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,555.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,003.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,278.69
|
| Rate for Payer: PHCS Commercial |
$19,866.00
|
| Rate for Payer: United Healthcare All Payer |
$18,210.50
|
|
|
HYDROSET XT INJ BNESUB CEM15CC
|
Facility
|
OP
|
$20,693.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,208.12 |
| Max. Negotiated Rate |
$19,866.00 |
| Rate for Payer: Aetna Commercial |
$15,934.19
|
| Rate for Payer: Anthem Medicaid |
$7,116.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,141.12
|
| Rate for Payer: Cash Price |
$10,346.88
|
| Rate for Payer: Cigna Commercial |
$17,175.81
|
| Rate for Payer: First Health Commercial |
$19,659.06
|
| Rate for Payer: Humana Commercial |
$17,589.69
|
| Rate for Payer: Humana KY Medicaid |
$7,116.58
|
| Rate for Payer: Kentucky WC Medicaid |
$7,189.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,968.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,271.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,208.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,259.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,210.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,520.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,555.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,003.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,278.69
|
| Rate for Payer: PHCS Commercial |
$19,866.00
|
| Rate for Payer: United Healthcare All Payer |
$18,210.50
|
|
|
HYDROSET XT INJ BNE SUB CEM 3C
|
Facility
|
OP
|
$5,539.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,661.94 |
| Max. Negotiated Rate |
$5,318.22 |
| Rate for Payer: Aetna Commercial |
$4,265.65
|
| Rate for Payer: Anthem Medicaid |
$1,905.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,321.05
|
| Rate for Payer: Cash Price |
$2,769.91
|
| Rate for Payer: Cigna Commercial |
$4,598.04
|
| Rate for Payer: First Health Commercial |
$5,262.82
|
| Rate for Payer: Humana Commercial |
$4,708.84
|
| Rate for Payer: Humana KY Medicaid |
$1,905.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,924.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,542.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,088.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,943.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,875.03
|
| Rate for Payer: Ohio Health Group HMO |
$4,154.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,431.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,819.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,822.47
|
| Rate for Payer: PHCS Commercial |
$5,318.22
|
| Rate for Payer: United Healthcare All Payer |
$4,875.03
|
|
|
HYDROSET XT INJ BNE SUB CEM 3C
|
Facility
|
IP
|
$5,539.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,661.94 |
| Max. Negotiated Rate |
$5,318.22 |
| Rate for Payer: Aetna Commercial |
$4,265.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,321.05
|
| Rate for Payer: Cash Price |
$2,769.91
|
| Rate for Payer: Cigna Commercial |
$4,598.04
|
| Rate for Payer: First Health Commercial |
$5,262.82
|
| Rate for Payer: Humana Commercial |
$4,708.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,542.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,088.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,875.03
|
| Rate for Payer: Ohio Health Group HMO |
$4,154.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,431.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,819.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,822.47
|
| Rate for Payer: PHCS Commercial |
$5,318.22
|
| Rate for Payer: United Healthcare All Payer |
$4,875.03
|
|
|
HYDROSET XT INJ BNE SUB CEM 5C
|
Facility
|
OP
|
$8,533.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,559.91 |
| Max. Negotiated Rate |
$8,191.71 |
| Rate for Payer: Aetna Commercial |
$6,570.43
|
| Rate for Payer: Anthem Medicaid |
$2,934.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,655.76
|
| Rate for Payer: Cash Price |
$4,266.52
|
| Rate for Payer: Cigna Commercial |
$7,082.41
|
| Rate for Payer: First Health Commercial |
$8,106.38
|
| Rate for Payer: Humana Commercial |
$7,253.08
|
| Rate for Payer: Humana KY Medicaid |
$2,934.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,964.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,997.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,297.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,559.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,993.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,509.07
|
| Rate for Payer: Ohio Health Group HMO |
$6,399.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,826.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,423.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,887.79
|
| Rate for Payer: PHCS Commercial |
$8,191.71
|
| Rate for Payer: United Healthcare All Payer |
$7,509.07
|
|
|
HYDROSET XT INJ BNE SUB CEM 5C
|
Facility
|
IP
|
$8,533.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,559.91 |
| Max. Negotiated Rate |
$8,191.71 |
| Rate for Payer: Aetna Commercial |
$6,570.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,655.76
|
| Rate for Payer: Cash Price |
$4,266.52
|
| Rate for Payer: Cigna Commercial |
$7,082.41
|
| Rate for Payer: First Health Commercial |
$8,106.38
|
| Rate for Payer: Humana Commercial |
$7,253.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,997.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,297.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,559.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,509.07
|
| Rate for Payer: Ohio Health Group HMO |
$6,399.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,826.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,423.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,887.79
|
| Rate for Payer: PHCS Commercial |
$8,191.71
|
| Rate for Payer: United Healthcare All Payer |
$7,509.07
|
|
|
HYDROXYZINE 25MG (100MG VIAL)
|
Facility
|
IP
|
$200.43
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
25002421
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$192.41 |
| Rate for Payer: Aetna Commercial |
$154.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.34
|
| Rate for Payer: Cash Price |
$100.22
|
| Rate for Payer: Cigna Commercial |
$166.36
|
| Rate for Payer: First Health Commercial |
$190.41
|
| Rate for Payer: Humana Commercial |
$170.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.38
|
| Rate for Payer: Ohio Health Group HMO |
$150.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.30
|
| Rate for Payer: PHCS Commercial |
$192.41
|
| Rate for Payer: United Healthcare All Payer |
$176.38
|
|
|
HYDROXYZINE 25MG (100MG VIAL)
|
Facility
|
OP
|
$200.43
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
25002421
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$192.41 |
| Rate for Payer: Aetna Commercial |
$154.33
|
| Rate for Payer: Anthem Medicaid |
$68.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.34
|
| Rate for Payer: Cash Price |
$100.22
|
| Rate for Payer: Cigna Commercial |
$166.36
|
| Rate for Payer: First Health Commercial |
$190.41
|
| Rate for Payer: Humana Commercial |
$170.37
|
| Rate for Payer: Humana KY Medicaid |
$68.93
|
| Rate for Payer: Kentucky WC Medicaid |
$69.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.38
|
| Rate for Payer: Ohio Health Group HMO |
$150.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.30
|
| Rate for Payer: PHCS Commercial |
$192.41
|
| Rate for Payer: United Healthcare All Payer |
$176.38
|
|
