|
KCENTRA 1U[500 unit vial]
|
Facility
|
IP
|
$6,090.92
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
25001809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,827.28 |
| Max. Negotiated Rate |
$5,847.28 |
| Rate for Payer: Aetna Commercial |
$4,690.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,750.92
|
| Rate for Payer: Cash Price |
$3,045.46
|
| Rate for Payer: Cigna Commercial |
$5,055.46
|
| Rate for Payer: First Health Commercial |
$5,786.37
|
| Rate for Payer: Humana Commercial |
$5,177.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,994.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,495.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,827.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,360.01
|
| Rate for Payer: Ohio Health Group HMO |
$4,568.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,872.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,299.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,202.73
|
| Rate for Payer: PHCS Commercial |
$5,847.28
|
| Rate for Payer: United Healthcare All Payer |
$5,360.01
|
|
|
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 |
$3,766.06 |
| 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 |
$10,042.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,921.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,661.94
|
| Rate for Payer: PHCS Commercial |
$12,051.39
|
| Rate for Payer: United Healthcare All Payer |
$11,047.11
|
|
|
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 |
$2.14 |
| 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 |
$2.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.89
|
| 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 |
$2.14
|
| 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 |
$2.57
|
| 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 |
$10,042.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,921.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,661.94
|
| 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 |
$34.28 |
| 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 |
$91.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.85
|
| 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 |
$34.28 |
| 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 |
$91.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.85
|
| Rate for Payer: PHCS Commercial |
$109.71
|
| Rate for Payer: United Healthcare All Payer |
$100.57
|
|
|
KCL 2mEq (20mEq SDV)
|
Facility
|
OP
|
$78.29
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.49 |
| Max. Negotiated Rate |
$75.16 |
| Rate for Payer: Aetna Commercial |
$60.28
|
| Rate for Payer: Anthem Medicaid |
$26.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.07
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cigna Commercial |
$64.98
|
| Rate for Payer: First Health Commercial |
$74.38
|
| Rate for Payer: Humana Commercial |
$66.55
|
| Rate for Payer: Humana KY Medicaid |
$26.92
|
| Rate for Payer: Kentucky WC Medicaid |
$27.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.90
|
| Rate for Payer: Ohio Health Group HMO |
$58.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.02
|
| Rate for Payer: PHCS Commercial |
$75.16
|
| Rate for Payer: United Healthcare All Payer |
$68.90
|
|
|
KCL 2mEq (20mEq SDV)
|
Facility
|
IP
|
$78.29
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.49 |
| Max. Negotiated Rate |
$75.16 |
| Rate for Payer: Aetna Commercial |
$60.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.07
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cigna Commercial |
$64.98
|
| Rate for Payer: First Health Commercial |
$74.38
|
| Rate for Payer: Humana Commercial |
$66.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.90
|
| Rate for Payer: Ohio Health Group HMO |
$58.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.02
|
| Rate for Payer: PHCS Commercial |
$75.16
|
| Rate for Payer: United Healthcare All Payer |
$68.90
|
|
|
KCL 2mEq (40mEq SDV)
|
Facility
|
IP
|
$112.06
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25003763
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.62 |
| 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 |
$84.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.32
|
| Rate for Payer: PHCS Commercial |
$107.58
|
| Rate for Payer: United Healthcare All Payer |
$98.61
|
|
|
KCL 2mEq (40mEq SDV)
|
Facility
|
OP
|
$112.06
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25003763
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.62 |
| 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 |
$84.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.32
|
| Rate for Payer: PHCS Commercial |
$107.58
|
| Rate for Payer: United Healthcare All Payer |
$98.61
|
|
|
KEELED GLENOID 40MM
|
Facility
|
OP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem Medicaid |
$3,028.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Humana KY Medicaid |
$3,028.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,089.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
KEELED GLENOID 40MM
|
Facility
|
IP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
KEELED GLENOID 46MM
|
Facility
|
IP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
KEELED GLENOID 46MM
|
Facility
|
OP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem Medicaid |
$3,028.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Humana KY Medicaid |
$3,028.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,089.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
KEELED GLENOID 52MM
|
Facility
|
IP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
KEELED GLENOID 52MM
|
Facility
|
OP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem Medicaid |
$3,028.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Humana KY Medicaid |
$3,028.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,089.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
KEFLEX(CEPHA)250 5000MG/100ML
|
Facility
|
OP
|
$9.15
|
|
|
Service Code
|
NDC 93417773
|
| Hospital Charge Code |
25000815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| 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 |
$2.75
|
| 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 |
$7.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.31
|
| 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 |
$2.75 |
| 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 |
$2.75
|
| 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 |
$7.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.31
|
| Rate for Payer: PHCS Commercial |
$8.78
|
| Rate for Payer: United Healthcare All Payer |
$8.05
|
|
|
KEFLEX (CEPHALEXIN) 250MG/1CAP
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 68180012101
|
| Hospital Charge Code |
25000812
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| 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 |
$3.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.02
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
KEFLEX (CEPHALEXIN) 250MG/1CAP
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 68180012101
|
| Hospital Charge Code |
25000812
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| 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 |
$3.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.02
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
KEFLEX (CEPHALEXIN) 500MG/1CAP
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 68180012201
|
| Hospital Charge Code |
25000814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| 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 |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| 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 |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
KEFLEX (CEPHALEXIN) 500MG/1CAP
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 68180012201
|
| Hospital Charge Code |
25000814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| 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 |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| 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 |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
KEISZ 4H GUIDE 8FR
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.50 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem Medicaid |
$383.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Humana KY Medicaid |
$383.45
|
| Rate for Payer: Kentucky WC Medicaid |
$387.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$769.35
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
|
KEISZ 4H GUIDE 8FR
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.50 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$769.35
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
|
KELLER TIMMERMANS SHEATH 22.0
|
Facility
|
OP
|
$3,717.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,115.25 |
| Max. Negotiated Rate |
$3,568.80 |
| Rate for Payer: Aetna Commercial |
$2,862.47
|
| Rate for Payer: Anthem Medicaid |
$1,278.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.65
|
| Rate for Payer: Cash Price |
$1,858.75
|
| Rate for Payer: Cigna Commercial |
$3,085.53
|
| Rate for Payer: First Health Commercial |
$3,531.62
|
| Rate for Payer: Humana Commercial |
$3,159.88
|
| Rate for Payer: Humana KY Medicaid |
$1,278.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,291.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,304.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,974.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.07
|
| Rate for Payer: PHCS Commercial |
$3,568.80
|
| Rate for Payer: United Healthcare All Payer |
$3,271.40
|
|
|
KELLER TIMMERMANS SHEATH 22.0
|
Facility
|
IP
|
$3,717.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,115.25 |
| Max. Negotiated Rate |
$3,568.80 |
| Rate for Payer: Aetna Commercial |
$2,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.65
|
| Rate for Payer: Cash Price |
$1,858.75
|
| Rate for Payer: Cigna Commercial |
$3,085.53
|
| Rate for Payer: First Health Commercial |
$3,531.62
|
| Rate for Payer: Humana Commercial |
$3,159.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,974.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.07
|
| Rate for Payer: PHCS Commercial |
$3,568.80
|
| Rate for Payer: United Healthcare All Payer |
$3,271.40
|
|
