|
MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
77000009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.30 |
| Max. Negotiated Rate |
$605.76 |
| Rate for Payer: Aetna Commercial |
$485.87
|
| Rate for Payer: Anthem Medicaid |
$217.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$492.18
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$523.73
|
| Rate for Payer: First Health Commercial |
$599.45
|
| Rate for Payer: Humana Commercial |
$536.35
|
| Rate for Payer: Humana KY Medicaid |
$217.00
|
| Rate for Payer: Kentucky WC Medicaid |
$219.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$517.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$465.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$221.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$555.28
|
| Rate for Payer: Ohio Health Group HMO |
$473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$504.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$435.39
|
| Rate for Payer: PHCS Commercial |
$605.76
|
| Rate for Payer: United Healthcare All Payer |
$555.28
|
|
|
MENB-FHBP VACC 2/3 DOSE IM
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
77000009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.30 |
| Max. Negotiated Rate |
$605.76 |
| Rate for Payer: Aetna Commercial |
$485.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$492.18
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$523.73
|
| Rate for Payer: First Health Commercial |
$599.45
|
| Rate for Payer: Humana Commercial |
$536.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$517.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$465.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$555.28
|
| Rate for Payer: Ohio Health Group HMO |
$473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$504.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$435.39
|
| Rate for Payer: PHCS Commercial |
$605.76
|
| Rate for Payer: United Healthcare All Payer |
$555.28
|
|
|
MENB-FHBP VACC 2/3 DOSE IM
|
Professional
|
Both
|
$631.00
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
77000009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$441.70 |
| Rate for Payer: Anthem Medicaid |
$95.75
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Humana Medicaid |
$95.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$267.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.67
|
| Rate for Payer: Molina Healthcare Passport |
$95.75
|
| Rate for Payer: Multiplan PHCS |
$378.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.70
|
| Rate for Payer: UHCCP Medicaid |
$220.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.71
|
|
|
MENB-FHBP VACC 2/3 DOSE IM(T
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
770T0009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.30 |
| Max. Negotiated Rate |
$605.76 |
| Rate for Payer: Aetna Commercial |
$485.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$492.18
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$523.73
|
| Rate for Payer: First Health Commercial |
$599.45
|
| Rate for Payer: Humana Commercial |
$536.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$517.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$465.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$555.28
|
| Rate for Payer: Ohio Health Group HMO |
$473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$504.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$435.39
|
| Rate for Payer: PHCS Commercial |
$605.76
|
| Rate for Payer: United Healthcare All Payer |
$555.28
|
|
|
MENB-FHBP VACC 2/3 DOSE IM(T
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
HCPCS 90621
|
| Hospital Charge Code |
770T0009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.30 |
| Max. Negotiated Rate |
$605.76 |
| Rate for Payer: Aetna Commercial |
$485.87
|
| Rate for Payer: Anthem Medicaid |
$217.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$492.18
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$523.73
|
| Rate for Payer: First Health Commercial |
$599.45
|
| Rate for Payer: Humana Commercial |
$536.35
|
| Rate for Payer: Humana KY Medicaid |
$217.00
|
| Rate for Payer: Kentucky WC Medicaid |
$219.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$517.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$465.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$221.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$555.28
|
| Rate for Payer: Ohio Health Group HMO |
$473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$504.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$435.39
|
| Rate for Payer: PHCS Commercial |
$605.76
|
| Rate for Payer: United Healthcare All Payer |
$555.28
|
|
|
MENEST 0.625MG TABLET
|
Facility
|
OP
|
$10.69
|
|
|
Service Code
|
NDC 61570007301
|
| Hospital Charge Code |
25000960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Aetna Commercial |
$8.23
|
| Rate for Payer: Anthem Medicaid |
$3.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.34
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cigna Commercial |
$8.87
|
| Rate for Payer: First Health Commercial |
$10.16
|
| Rate for Payer: Humana Commercial |
$9.09
|
| Rate for Payer: Humana KY Medicaid |
$3.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.41
|
| Rate for Payer: Ohio Health Group HMO |
$8.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.38
|
| Rate for Payer: PHCS Commercial |
$10.26
|
| Rate for Payer: United Healthcare All Payer |
$9.41
|
|
|
MENEST 0.625MG TABLET
|
Facility
|
IP
|
$10.69
|
|
|
Service Code
|
NDC 61570007301
|
| Hospital Charge Code |
25000960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$10.26 |
| Rate for Payer: Aetna Commercial |
$8.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.34
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cigna Commercial |
$8.87
|
| Rate for Payer: First Health Commercial |
$10.16
|
| Rate for Payer: Humana Commercial |
$9.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.41
|
| Rate for Payer: Ohio Health Group HMO |
$8.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.38
|
| Rate for Payer: PHCS Commercial |
$10.26
|
| Rate for Payer: United Healthcare All Payer |
$9.41
|
|
|
MENIGOCOCCAL POLYSACC VAC .5ML
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
HCPCS 90733
|
| Hospital Charge Code |
77000047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.12
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
MENIGOCOCCAL POLYSACC VAC .5ML
|
Professional
|
Both
|
$548.00
|
|
|
Service Code
|
HCPCS 90733
|
| Hospital Charge Code |
77000047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.49 |
| Max. Negotiated Rate |
$383.60 |
| Rate for Payer: Anthem Medicaid |
$106.49
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Healthspan PPO |
$116.23
|
| Rate for Payer: Humana Medicaid |
$106.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$195.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.62
|
| Rate for Payer: Molina Healthcare Passport |
$106.49
|
| Rate for Payer: Multiplan PHCS |
$328.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$383.60
|
| Rate for Payer: UHCCP Medicaid |
$191.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.55
|
|
|
MENIGOCOCCAL POLYSACC VAC .5ML
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
HCPCS 90733
|
| Hospital Charge Code |
77000047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem Medicaid |
$188.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Humana KY Medicaid |
$188.46
|
| Rate for Payer: Kentucky WC Medicaid |
$190.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.12
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
MENIGOCOCCAL POLYSACC VAC .5ML
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
HCPCS 90733
|
| Hospital Charge Code |
770T0047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.12
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
MENIGOCOCCAL POLYSACC VAC .5ML
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
HCPCS 90733
|
| Hospital Charge Code |
770T0047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem Medicaid |
$188.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Humana KY Medicaid |
$188.46
|
| Rate for Payer: Kentucky WC Medicaid |
$190.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.12
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
30002087
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.05
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 87801
|
| Hospital Charge Code |
30002087
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$70.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$70.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$98.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$70.20
|
| Rate for Payer: Humana Medicare Advantage |
$70.20
|
| Rate for Payer: Kentucky WC Medicaid |
$70.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
MENISCAL CINCH CVD TIP
|
Facility
|
IP
|
$3,068.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.62 |
| Max. Negotiated Rate |
$2,946.00 |
| Rate for Payer: Aetna Commercial |
$2,362.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,393.62
|
| Rate for Payer: Cash Price |
$1,534.38
|
| Rate for Payer: Cigna Commercial |
$2,547.06
|
| Rate for Payer: First Health Commercial |
$2,915.31
|
| Rate for Payer: Humana Commercial |
$2,608.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,516.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,264.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,700.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,301.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,669.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,117.44
|
| Rate for Payer: PHCS Commercial |
$2,946.00
|
| Rate for Payer: United Healthcare All Payer |
$2,700.50
|
|
|
MENISCAL CINCH CVD TIP
|
Facility
|
OP
|
$3,068.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.62 |
| Max. Negotiated Rate |
$2,946.00 |
| Rate for Payer: Aetna Commercial |
$2,362.94
|
| Rate for Payer: Anthem Medicaid |
$1,055.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,393.62
|
| Rate for Payer: Cash Price |
$1,534.38
|
| Rate for Payer: Cigna Commercial |
$2,547.06
|
| Rate for Payer: First Health Commercial |
$2,915.31
|
| Rate for Payer: Humana Commercial |
$2,608.44
|
| Rate for Payer: Humana KY Medicaid |
$1,055.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,066.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,516.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,264.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,076.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,700.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,301.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,669.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,117.44
|
| Rate for Payer: PHCS Commercial |
$2,946.00
|
| Rate for Payer: United Healthcare All Payer |
$2,700.50
|
|
|
MENVEO VAC 0.5 ML INJECTION
|
Facility
|
IP
|
$584.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
25004043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.38 |
| Max. Negotiated Rate |
$561.22 |
| Rate for Payer: Aetna Commercial |
$450.14
|
| Rate for Payer: Aetna Commercial |
$457.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$463.32
|
| Rate for Payer: Cash Price |
$292.30
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$485.22
|
| Rate for Payer: Cigna Commercial |
$493.02
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: First Health Commercial |
$555.37
|
| Rate for Payer: Humana Commercial |
$504.90
|
| Rate for Payer: Humana Commercial |
$496.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$438.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$522.72
|
| Rate for Payer: Ohio Health Group HMO |
$438.45
|
| Rate for Payer: Ohio Health Group HMO |
$445.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.37
|
| Rate for Payer: PHCS Commercial |
$561.22
|
| Rate for Payer: PHCS Commercial |
$570.24
|
| Rate for Payer: United Healthcare All Payer |
$514.45
|
| Rate for Payer: United Healthcare All Payer |
$522.72
|
|
|
MENVEO VAC 0.5 ML INJECTION
|
Facility
|
OP
|
$584.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
25004043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.38 |
| Max. Negotiated Rate |
$561.22 |
| Rate for Payer: Aetna Commercial |
$450.14
|
| Rate for Payer: Aetna Commercial |
$457.38
|
| Rate for Payer: Anthem Medicaid |
$201.04
|
| Rate for Payer: Anthem Medicaid |
$204.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$463.32
|
| Rate for Payer: Cash Price |
$292.30
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$493.02
|
| Rate for Payer: Cigna Commercial |
$485.22
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: First Health Commercial |
$555.37
|
| Rate for Payer: Humana Commercial |
$496.91
|
| Rate for Payer: Humana Commercial |
$504.90
|
| Rate for Payer: Humana KY Medicaid |
$201.04
|
| Rate for Payer: Humana KY Medicaid |
$204.28
|
| Rate for Payer: Kentucky WC Medicaid |
$206.36
|
| Rate for Payer: Kentucky WC Medicaid |
$203.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$438.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$522.72
|
| Rate for Payer: Ohio Health Group HMO |
$438.45
|
| Rate for Payer: Ohio Health Group HMO |
$445.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.86
|
| Rate for Payer: PHCS Commercial |
$570.24
|
| Rate for Payer: PHCS Commercial |
$561.22
|
| Rate for Payer: United Healthcare All Payer |
$522.72
|
| Rate for Payer: United Healthcare All Payer |
$514.45
|
|
|
MEPHYTON (PHYTONADION 5MG/1TAB
|
Facility
|
IP
|
$66.13
|
|
|
Service Code
|
NDC 70710101403
|
| Hospital Charge Code |
25000961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna Commercial |
$50.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.58
|
| Rate for Payer: Cash Price |
$33.06
|
| Rate for Payer: Cigna Commercial |
$54.89
|
| Rate for Payer: First Health Commercial |
$62.82
|
| Rate for Payer: Humana Commercial |
$56.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.19
|
| Rate for Payer: Ohio Health Group HMO |
$49.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.63
|
| Rate for Payer: PHCS Commercial |
$63.48
|
| Rate for Payer: United Healthcare All Payer |
$58.19
|
|
|
MEPHYTON (PHYTONADION 5MG/1TAB
|
Facility
|
OP
|
$66.13
|
|
|
Service Code
|
NDC 70710101403
|
| Hospital Charge Code |
25000961
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna Commercial |
$50.92
|
| Rate for Payer: Anthem Medicaid |
$22.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.58
|
| Rate for Payer: Cash Price |
$33.06
|
| Rate for Payer: Cigna Commercial |
$54.89
|
| Rate for Payer: First Health Commercial |
$62.82
|
| Rate for Payer: Humana Commercial |
$56.21
|
| Rate for Payer: Humana KY Medicaid |
$22.74
|
| Rate for Payer: Kentucky WC Medicaid |
$22.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.19
|
| Rate for Payer: Ohio Health Group HMO |
$49.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.63
|
| Rate for Payer: PHCS Commercial |
$63.48
|
| Rate for Payer: United Healthcare All Payer |
$58.19
|
|
|
MEPRON(ATOVAQUON)750MG/5MLSUSP
|
Facility
|
IP
|
$73.86
|
|
|
Service Code
|
NDC 173066518
|
| Hospital Charge Code |
25000962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$70.91 |
| Rate for Payer: Aetna Commercial |
$56.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.61
|
| Rate for Payer: Cash Price |
$36.93
|
| Rate for Payer: Cigna Commercial |
$61.30
|
| Rate for Payer: First Health Commercial |
$70.17
|
| Rate for Payer: Humana Commercial |
$62.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.00
|
| Rate for Payer: Ohio Health Group HMO |
$55.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.96
|
| Rate for Payer: PHCS Commercial |
$70.91
|
| Rate for Payer: United Healthcare All Payer |
$65.00
|
|
|
MEPRON(ATOVAQUON)750MG/5MLSUSP
|
Facility
|
OP
|
$73.86
|
|
|
Service Code
|
NDC 173066518
|
| Hospital Charge Code |
25000962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$70.91 |
| Rate for Payer: Aetna Commercial |
$56.87
|
| Rate for Payer: Anthem Medicaid |
$25.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.61
|
| Rate for Payer: Cash Price |
$36.93
|
| Rate for Payer: Cigna Commercial |
$61.30
|
| Rate for Payer: First Health Commercial |
$70.17
|
| Rate for Payer: Humana Commercial |
$62.78
|
| Rate for Payer: Humana KY Medicaid |
$25.40
|
| Rate for Payer: Kentucky WC Medicaid |
$25.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.00
|
| Rate for Payer: Ohio Health Group HMO |
$55.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.96
|
| Rate for Payer: PHCS Commercial |
$70.91
|
| Rate for Payer: United Healthcare All Payer |
$65.00
|
|
|
MERREM 100MG(GEN) 1G V
|
Facility
|
IP
|
$112.90
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
25002228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$108.38 |
| Rate for Payer: Aetna Commercial |
$86.93
|
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$56.45
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$93.71
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: First Health Commercial |
$107.25
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Humana Commercial |
$95.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$84.67
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.90
|
| Rate for Payer: PHCS Commercial |
$108.38
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$99.35
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
MERREM 100MG(GEN) 1G V
|
Facility
|
OP
|
$112.90
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
25002228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$108.38 |
| Rate for Payer: Aetna Commercial |
$86.93
|
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem Medicaid |
$38.83
|
| Rate for Payer: Anthem Medicaid |
$40.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$56.45
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: Cigna Commercial |
$93.71
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: First Health Commercial |
$107.25
|
| Rate for Payer: Humana Commercial |
$95.97
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Humana KY Medicaid |
$38.83
|
| Rate for Payer: Humana KY Medicaid |
$40.58
|
| Rate for Payer: Kentucky WC Medicaid |
$40.99
|
| Rate for Payer: Kentucky WC Medicaid |
$39.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$84.67
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: PHCS Commercial |
$108.38
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
| Rate for Payer: United Healthcare All Payer |
$99.35
|
|
|
MERREM 100MG(GEN) 500MG V
|
Facility
|
IP
|
$16.35
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
25002227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$15.70 |
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.75
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cigna Commercial |
$13.57
|
| Rate for Payer: First Health Commercial |
$15.53
|
| Rate for Payer: Humana Commercial |
$13.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.39
|
| Rate for Payer: Ohio Health Group HMO |
$12.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.28
|
| Rate for Payer: PHCS Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Payer |
$14.39
|
|
