|
KCENTRA 1U[500 unit vial]
|
Facility
|
IP
|
$6,498.58
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
25001809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$844.82 |
| Max. Negotiated Rate |
$6,238.64 |
| Rate for Payer: Aetna Commercial |
$5,003.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,068.89
|
| Rate for Payer: Cash Price |
$3,249.29
|
| Rate for Payer: Cigna Commercial |
$5,393.82
|
| Rate for Payer: First Health Commercial |
$6,173.65
|
| Rate for Payer: Humana Commercial |
$5,523.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,328.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,795.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,949.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,718.75
|
| Rate for Payer: Ohio Health Group HMO |
$4,873.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,299.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$844.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,014.56
|
| Rate for Payer: PHCS Commercial |
$6,238.64
|
| Rate for Payer: United Healthcare All Payer |
$5,718.75
|
|
|
KCENTRA 1 UNIT (1000UNIT/40ML)
|
Facility
|
OP
|
$12,553.53
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
25003824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$12,051.39 |
| Rate for Payer: Aetna Commercial |
$9,666.22
|
| Rate for Payer: Anthem Medicaid |
$4,317.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.08
|
| Rate for Payer: Cash Price |
$6,276.76
|
| Rate for Payer: Cash Price |
$6,276.76
|
| Rate for Payer: Cigna Commercial |
$10,419.43
|
| Rate for Payer: First Health Commercial |
$11,925.85
|
| Rate for Payer: Humana Commercial |
$10,670.50
|
| Rate for Payer: Humana KY Medicaid |
$4,317.16
|
| Rate for Payer: Humana Medicare Advantage |
$2.28
|
| Rate for Payer: Kentucky WC Medicaid |
$4,361.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,264.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,403.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,047.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,415.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.59
|
| Rate for Payer: PHCS Commercial |
$12,051.39
|
| Rate for Payer: United Healthcare All Payer |
$11,047.11
|
|
|
KCENTRA 1 UNIT (1000UNIT/40ML)
|
Facility
|
IP
|
$12,553.53
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
25003824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,631.96 |
| Max. Negotiated Rate |
$12,051.39 |
| Rate for Payer: Aetna Commercial |
$9,666.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.75
|
| Rate for Payer: Cash Price |
$6,276.76
|
| Rate for Payer: Cigna Commercial |
$10,419.43
|
| Rate for Payer: First Health Commercial |
$11,925.85
|
| Rate for Payer: Humana Commercial |
$10,670.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,264.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,766.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,047.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,415.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.59
|
| Rate for Payer: PHCS Commercial |
$12,051.39
|
| Rate for Payer: United Healthcare All Payer |
$11,047.11
|
|
|
KCL 20mEq/L in D5/w 1,000mL
|
Facility
|
OP
|
$114.28
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25004169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$109.71 |
| Rate for Payer: Aetna Commercial |
$88.00
|
| Rate for Payer: Anthem Medicaid |
$39.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.14
|
| Rate for Payer: Cash Price |
$57.14
|
| Rate for Payer: Cigna Commercial |
$94.85
|
| Rate for Payer: First Health Commercial |
$108.57
|
| Rate for Payer: Humana Commercial |
$97.14
|
| Rate for Payer: Humana KY Medicaid |
$39.30
|
| Rate for Payer: Kentucky WC Medicaid |
$39.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.57
|
| Rate for Payer: Ohio Health Group HMO |
$85.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.43
|
| Rate for Payer: PHCS Commercial |
$109.71
|
| Rate for Payer: United Healthcare All Payer |
$100.57
|
|
|
KCL 20mEq/L in D5/w 1,000mL
|
Facility
|
IP
|
$114.28
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25004169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$109.71 |
| Rate for Payer: Aetna Commercial |
$88.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.14
|
| Rate for Payer: Cash Price |
$57.14
|
| Rate for Payer: Cigna Commercial |
$94.85
|
| Rate for Payer: First Health Commercial |
$108.57
|
| Rate for Payer: Humana Commercial |
$97.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.57
|
| Rate for Payer: Ohio Health Group HMO |
$85.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.43
|
| Rate for Payer: PHCS Commercial |
$109.71
|
| Rate for Payer: United Healthcare All Payer |
$100.57
|
|
|
KCL 2mEq (20mEq SDV)
|
Facility
|
IP
|
$78.01
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$74.89 |
| Rate for Payer: Aetna Commercial |
$60.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.85
|
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: Cigna Commercial |
$64.75
|
| Rate for Payer: First Health Commercial |
$74.11
|
| Rate for Payer: Humana Commercial |
$66.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.65
|
| Rate for Payer: Ohio Health Group HMO |
$58.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.18
|
| Rate for Payer: PHCS Commercial |
$74.89
|
| Rate for Payer: United Healthcare All Payer |
$68.65
|
|
|
KCL 2mEq (20mEq SDV)
|
Facility
|
OP
|
$78.01
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$74.89 |
| Rate for Payer: Aetna Commercial |
$60.07
|
| Rate for Payer: Anthem Medicaid |
$26.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.85
|
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: Cigna Commercial |
$64.75
|
| Rate for Payer: First Health Commercial |
$74.11
|
| Rate for Payer: Humana Commercial |
$66.31
|
| Rate for Payer: Humana KY Medicaid |
$26.83
|
| Rate for Payer: Kentucky WC Medicaid |
$27.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.65
|
| Rate for Payer: Ohio Health Group HMO |
$58.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.18
|
| Rate for Payer: PHCS Commercial |
$74.89
|
| Rate for Payer: United Healthcare All Payer |
$68.65
|
|
|
KCL 2mEq (40mEq SDV)
|
Facility
|
OP
|
$112.06
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25003763
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$107.58 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Anthem Medicaid |
$38.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.41
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cigna Commercial |
$93.01
|
| Rate for Payer: First Health Commercial |
$106.46
|
| Rate for Payer: Humana Commercial |
$95.25
|
| Rate for Payer: Humana KY Medicaid |
$38.54
|
| Rate for Payer: Kentucky WC Medicaid |
$38.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.61
|
| Rate for Payer: Ohio Health Group HMO |
$84.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.74
|
| Rate for Payer: PHCS Commercial |
$107.58
|
| Rate for Payer: United Healthcare All Payer |
$98.61
|
|
|
KCL 2mEq (40mEq SDV)
|
Facility
|
IP
|
$112.06
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25003763
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$107.58 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.41
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cigna Commercial |
$93.01
|
| Rate for Payer: First Health Commercial |
$106.46
|
| Rate for Payer: Humana Commercial |
$95.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.61
|
| Rate for Payer: Ohio Health Group HMO |
$84.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.74
|
| Rate for Payer: PHCS Commercial |
$107.58
|
| Rate for Payer: United Healthcare All Payer |
$98.61
|
|
|
KEELED GLENOID 40MM
|
Facility
|
IP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.93 |
| Max. Negotiated Rate |
$8,262.86 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
| Rate for Payer: United Healthcare All Payer |
$7,574.29
|
|
|
KEELED GLENOID 40MM
|
Facility
|
OP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.93 |
| Max. Negotiated Rate |
$8,262.86 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem Medicaid |
$2,960.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Humana KY Medicaid |
$2,960.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,990.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,019.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
| Rate for Payer: United Healthcare All Payer |
$7,574.29
|
|
|
KEELED GLENOID 46MM
|
Facility
|
OP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.93 |
| Max. Negotiated Rate |
$8,262.86 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem Medicaid |
$2,960.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Humana KY Medicaid |
$2,960.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,990.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,019.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
| Rate for Payer: United Healthcare All Payer |
$7,574.29
|
|
|
KEELED GLENOID 46MM
|
Facility
|
IP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.93 |
| Max. Negotiated Rate |
$8,262.86 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
| Rate for Payer: United Healthcare All Payer |
$7,574.29
|
|
|
KEELED GLENOID 52MM
|
Facility
|
IP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.93 |
| Max. Negotiated Rate |
$8,262.86 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
| Rate for Payer: United Healthcare All Payer |
$7,574.29
|
|
|
KEELED GLENOID 52MM
|
Facility
|
OP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.93 |
| Max. Negotiated Rate |
$8,262.86 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem Medicaid |
$2,960.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Humana KY Medicaid |
$2,960.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,990.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,019.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
| Rate for Payer: United Healthcare All Payer |
$7,574.29
|
|
|
KEFLEX(CEPHA)250 5000MG/100ML
|
Facility
|
OP
|
$9.15
|
|
|
Service Code
|
NDC 93417773
|
| Hospital Charge Code |
25000815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Anthem Medicaid |
$3.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.59
|
| Rate for Payer: First Health Commercial |
$8.69
|
| Rate for Payer: Humana Commercial |
$7.78
|
| Rate for Payer: Humana KY Medicaid |
$3.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.05
|
| Rate for Payer: Ohio Health Group HMO |
$6.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.84
|
| Rate for Payer: PHCS Commercial |
$8.78
|
| Rate for Payer: United Healthcare All Payer |
$8.05
|
|
|
KEFLEX(CEPHA)250 5000MG/100ML
|
Facility
|
IP
|
$9.15
|
|
|
Service Code
|
NDC 93417773
|
| Hospital Charge Code |
25000815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.59
|
| Rate for Payer: First Health Commercial |
$8.69
|
| Rate for Payer: Humana Commercial |
$7.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.05
|
| Rate for Payer: Ohio Health Group HMO |
$6.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.84
|
| Rate for Payer: PHCS Commercial |
$8.78
|
| Rate for Payer: United Healthcare All Payer |
$8.05
|
|
|
KEFLEX (CEPHALEXIN) 250MG/1CAP
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 68180012101
|
| Hospital Charge Code |
25000812
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
KEFLEX (CEPHALEXIN) 250MG/1CAP
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 68180012101
|
| Hospital Charge Code |
25000812
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
KEFLEX (CEPHALEXIN) 500MG/1CAP
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 68180012201
|
| Hospital Charge Code |
25000814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
KEFLEX (CEPHALEXIN) 500MG/1CAP
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 68180012201
|
| Hospital Charge Code |
25000814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
KEISZ 4H GUIDE 8FR
|
Facility
|
IP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
KEISZ 4H GUIDE 8FR
|
Facility
|
OP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem Medicaid |
$370.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Humana KY Medicaid |
$370.69
|
| Rate for Payer: Kentucky WC Medicaid |
$374.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
KELLER TIMMERMANS SHEATH 22.0
|
Facility
|
IP
|
$3,803.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.39 |
| Max. Negotiated Rate |
$3,650.88 |
| Rate for Payer: Aetna Commercial |
$2,928.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.34
|
| Rate for Payer: Cash Price |
$1,901.50
|
| Rate for Payer: Cigna Commercial |
$3,156.49
|
| Rate for Payer: First Health Commercial |
$3,612.85
|
| Rate for Payer: Humana Commercial |
$3,232.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,118.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,806.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,346.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.93
|
| Rate for Payer: PHCS Commercial |
$3,650.88
|
| Rate for Payer: United Healthcare All Payer |
$3,346.64
|
|
|
KELLER TIMMERMANS SHEATH 22.0
|
Facility
|
OP
|
$3,803.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.39 |
| Max. Negotiated Rate |
$3,650.88 |
| Rate for Payer: Aetna Commercial |
$2,928.31
|
| Rate for Payer: Anthem Medicaid |
$1,307.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.34
|
| Rate for Payer: Cash Price |
$1,901.50
|
| Rate for Payer: Cigna Commercial |
$3,156.49
|
| Rate for Payer: First Health Commercial |
$3,612.85
|
| Rate for Payer: Humana Commercial |
$3,232.55
|
| Rate for Payer: Humana KY Medicaid |
$1,307.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,321.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,118.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,806.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,334.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,346.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.93
|
| Rate for Payer: PHCS Commercial |
$3,650.88
|
| Rate for Payer: United Healthcare All Payer |
$3,346.64
|
|
