|
NONTRAUMATIC STUPOR AND COMA WITH MCC
|
Facility
|
IP
|
$25,837.83
|
|
|
Service Code
|
MSDRG 080
|
| Min. Negotiated Rate |
$17,532.81 |
| Max. Negotiated Rate |
$25,837.83 |
| Rate for Payer: Anthem Medicaid |
$17,532.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,455.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25,837.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$24,915.05
|
| Rate for Payer: Humana KY Medicaid |
$17,532.81
|
| Rate for Payer: Humana Medicare Advantage |
$18,455.59
|
| Rate for Payer: Kentucky WC Medicaid |
$17,708.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,146.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,883.47
|
|
|
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC
|
Facility
|
IP
|
$10,639.52
|
|
|
Service Code
|
MSDRG 081
|
| Min. Negotiated Rate |
$7,219.68 |
| Max. Negotiated Rate |
$10,639.52 |
| Rate for Payer: Anthem Medicaid |
$7,219.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,599.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,639.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,259.54
|
| Rate for Payer: Humana KY Medicaid |
$7,219.68
|
| Rate for Payer: Humana Medicare Advantage |
$7,599.66
|
| Rate for Payer: Kentucky WC Medicaid |
$7,291.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,119.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,364.07
|
|
|
NON-TRAUM DEHISC REP,VAG CUFF
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Anthem Medicaid |
$570.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$570.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$581.40
|
| Rate for Payer: Molina Healthcare Passport |
$570.00
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$575.70
|
|
|
NON-TRAUM DEHISC REP,VAG CUFF
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
NON-TRAUM DEHISC REP,VAG CUFF
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
NONVASCULAR SHUNT X-RAY
|
Professional
|
Both
|
$690.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
32000285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$131.12
|
| Rate for Payer: Anthem Medicaid |
$40.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$690.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$96.03
|
| Rate for Payer: Healthspan PPO |
$122.86
|
| Rate for Payer: Humana Medicaid |
$40.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.77
|
| Rate for Payer: Molina Healthcare Passport |
$40.95
|
| Rate for Payer: Multiplan PHCS |
$414.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$483.00
|
| Rate for Payer: UHCCP Medicaid |
$241.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.36
|
|
|
NONVASCULAR SHUNT X-RAY
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
32000285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
NONVASCULAR SHUNT X-RAY
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
32000285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem Medicaid |
$237.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Humana KY Medicaid |
$237.29
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$239.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$242.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
NONVASCULAR SHUNT X-RAY(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
320P0285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$131.12 |
| Rate for Payer: Aetna Commercial |
$131.12
|
| Rate for Payer: Anthem Medicaid |
$40.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$96.03
|
| Rate for Payer: Healthspan PPO |
$122.86
|
| Rate for Payer: Humana Medicaid |
$40.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.77
|
| Rate for Payer: Molina Healthcare Passport |
$40.95
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.36
|
|
|
NONVASCULAR SHUNT X-RAY(T
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
320T0285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$566.40 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Anthem Medicaid |
$202.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$489.70
|
| Rate for Payer: First Health Commercial |
$560.50
|
| Rate for Payer: Humana Commercial |
$501.50
|
| Rate for Payer: Humana KY Medicaid |
$202.90
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$204.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$483.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.20
|
| Rate for Payer: Ohio Health Group HMO |
$442.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.90
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
NONVASCULAR SHUNT X-RAY(T
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
HCPCS 75809
|
| Hospital Charge Code |
320T0285
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$566.40 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.20
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$489.70
|
| Rate for Payer: First Health Commercial |
$560.50
|
| Rate for Payer: Humana Commercial |
$501.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$483.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.20
|
| Rate for Payer: Ohio Health Group HMO |
$442.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.90
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
NORCO 10/325MG EQ TABLET
|
Facility
|
OP
|
$60.22
|
|
|
Service Code
|
NDC 406012501
|
| Hospital Charge Code |
25001094
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$57.81 |
| Rate for Payer: Aetna Commercial |
$46.37
|
| Rate for Payer: Anthem Medicaid |
$20.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.97
|
| Rate for Payer: Cash Price |
$30.11
|
| Rate for Payer: Cigna Commercial |
$49.98
|
| Rate for Payer: First Health Commercial |
$57.21
|
| Rate for Payer: Humana Commercial |
$51.19
|
| Rate for Payer: Humana KY Medicaid |
$20.71
|
| Rate for Payer: Kentucky WC Medicaid |
$20.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.99
|
| Rate for Payer: Ohio Health Group HMO |
$45.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.67
|
| Rate for Payer: PHCS Commercial |
$57.81
|
| Rate for Payer: United Healthcare All Payer |
$52.99
|
|
|
NORCO 10/325MG EQ TABLET
|
Facility
|
IP
|
$60.22
|
|
|
Service Code
|
NDC 406012501
|
| Hospital Charge Code |
25001094
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$57.81 |
| Rate for Payer: Aetna Commercial |
$46.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.97
|
| Rate for Payer: Cash Price |
$30.11
|
| Rate for Payer: Cigna Commercial |
$49.98
|
| Rate for Payer: First Health Commercial |
$57.21
|
| Rate for Payer: Humana Commercial |
$51.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.99
|
| Rate for Payer: Ohio Health Group HMO |
$45.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.67
|
| Rate for Payer: PHCS Commercial |
$57.81
|
| Rate for Payer: United Healthcare All Payer |
$52.99
|
|
|
NORCO 5/325MG EQ TABLET
|
Facility
|
IP
|
$60.10
|
|
|
Service Code
|
NDC 27808003501
|
| Hospital Charge Code |
25001095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$57.70 |
| Rate for Payer: Humana Commercial |
$51.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.89
|
| Rate for Payer: Ohio Health Group HMO |
$45.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.63
|
| Rate for Payer: PHCS Commercial |
$57.70
|
| Rate for Payer: United Healthcare All Payer |
$52.89
|
| Rate for Payer: Aetna Commercial |
$46.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.88
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cigna Commercial |
$49.88
|
| Rate for Payer: First Health Commercial |
$57.10
|
|
|
NORCO 5/325MG EQ TABLET
|
Facility
|
OP
|
$60.10
|
|
|
Service Code
|
NDC 27808003501
|
| Hospital Charge Code |
25001095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$57.70 |
| Rate for Payer: Aetna Commercial |
$46.28
|
| Rate for Payer: Anthem Medicaid |
$20.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.88
|
| Rate for Payer: Cash Price |
$30.05
|
| Rate for Payer: Cigna Commercial |
$49.88
|
| Rate for Payer: First Health Commercial |
$57.10
|
| Rate for Payer: Humana Commercial |
$51.08
|
| Rate for Payer: Humana KY Medicaid |
$20.67
|
| Rate for Payer: Kentucky WC Medicaid |
$20.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.89
|
| Rate for Payer: Ohio Health Group HMO |
$45.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.63
|
| Rate for Payer: PHCS Commercial |
$57.70
|
| Rate for Payer: United Healthcare All Payer |
$52.89
|
|
|
NORCO 7.5/325MG EQ TABLET
|
Facility
|
OP
|
$60.21
|
|
|
Service Code
|
NDC 406012401
|
| Hospital Charge Code |
25001096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Anthem Medicaid |
$20.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.96
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: Cigna Commercial |
$49.97
|
| Rate for Payer: First Health Commercial |
$57.20
|
| Rate for Payer: Humana Commercial |
$51.18
|
| Rate for Payer: Humana KY Medicaid |
$20.71
|
| Rate for Payer: Kentucky WC Medicaid |
$20.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.98
|
| Rate for Payer: Ohio Health Group HMO |
$45.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.67
|
| Rate for Payer: PHCS Commercial |
$57.80
|
| Rate for Payer: United Healthcare All Payer |
$52.98
|
|
|
NORCO 7.5/325MG EQ TABLET
|
Facility
|
IP
|
$60.21
|
|
|
Service Code
|
NDC 406012401
|
| Hospital Charge Code |
25001096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.96
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: Cigna Commercial |
$49.97
|
| Rate for Payer: First Health Commercial |
$57.20
|
| Rate for Payer: Humana Commercial |
$51.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.98
|
| Rate for Payer: Ohio Health Group HMO |
$45.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.67
|
| Rate for Payer: PHCS Commercial |
$57.80
|
| Rate for Payer: United Healthcare All Payer |
$52.98
|
|
|
NORCURON (VERCURONIU 10MG/10ML
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
NDC 55150023501
|
| Hospital Charge Code |
25003298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem Medicaid |
$38.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Humana KY Medicaid |
$38.52
|
| Rate for Payer: Kentucky WC Medicaid |
$38.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.72
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
NORCURON (VERCURONIU 10MG/10ML
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
NDC 55150023501
|
| Hospital Charge Code |
25003298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.72
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
NOREPINEPHRINE 64MCG/ML 250ML
|
Facility
|
IP
|
$203.25
|
|
|
Service Code
|
NDC 63323094004
|
| Hospital Charge Code |
25003299
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$195.12 |
| Rate for Payer: Aetna Commercial |
$156.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.54
|
| Rate for Payer: Cash Price |
$101.62
|
| Rate for Payer: Cigna Commercial |
$168.70
|
| Rate for Payer: First Health Commercial |
$193.09
|
| Rate for Payer: Humana Commercial |
$172.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.86
|
| Rate for Payer: Ohio Health Group HMO |
$152.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.01
|
| Rate for Payer: PHCS Commercial |
$195.12
|
| Rate for Payer: United Healthcare All Payer |
$178.86
|
|
|
NOREPINEPHRINE 64MCG/ML 250ML
|
Facility
|
OP
|
$203.25
|
|
|
Service Code
|
NDC 63323094004
|
| Hospital Charge Code |
25003299
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$195.12 |
| Rate for Payer: Humana Commercial |
$172.76
|
| Rate for Payer: Humana KY Medicaid |
$69.90
|
| Rate for Payer: Kentucky WC Medicaid |
$70.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.86
|
| Rate for Payer: Ohio Health Group HMO |
$152.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.01
|
| Rate for Payer: PHCS Commercial |
$195.12
|
| Rate for Payer: United Healthcare All Payer |
$178.86
|
| Rate for Payer: Aetna Commercial |
$156.50
|
| Rate for Payer: Anthem Medicaid |
$69.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.54
|
| Rate for Payer: Cash Price |
$101.62
|
| Rate for Payer: Cigna Commercial |
$168.70
|
| Rate for Payer: First Health Commercial |
$193.09
|
|
|
NORFLEX 60MG/2ML INJECTION
|
Facility
|
IP
|
$117.86
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$113.15 |
| Rate for Payer: Aetna Commercial |
$90.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.93
|
| Rate for Payer: Cash Price |
$58.93
|
| Rate for Payer: Cigna Commercial |
$97.82
|
| Rate for Payer: First Health Commercial |
$111.97
|
| Rate for Payer: Humana Commercial |
$100.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.72
|
| Rate for Payer: Ohio Health Group HMO |
$88.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.54
|
| Rate for Payer: PHCS Commercial |
$113.15
|
| Rate for Payer: United Healthcare All Payer |
$103.72
|
|
|
NORFLEX 60MG/2ML INJECTION
|
Facility
|
IP
|
$117.86
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
636T0045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$113.15 |
| Rate for Payer: Aetna Commercial |
$90.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.93
|
| Rate for Payer: Cash Price |
$58.93
|
| Rate for Payer: Cigna Commercial |
$97.82
|
| Rate for Payer: First Health Commercial |
$111.97
|
| Rate for Payer: Humana Commercial |
$100.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.72
|
| Rate for Payer: Ohio Health Group HMO |
$88.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.54
|
| Rate for Payer: PHCS Commercial |
$113.15
|
| Rate for Payer: United Healthcare All Payer |
$103.72
|
|
|
NORFLEX 60MG/2ML INJECTION
|
Facility
|
OP
|
$117.86
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$113.15 |
| Rate for Payer: Aetna Commercial |
$90.75
|
| Rate for Payer: Anthem Medicaid |
$40.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.93
|
| Rate for Payer: Cash Price |
$58.93
|
| Rate for Payer: Cigna Commercial |
$97.82
|
| Rate for Payer: First Health Commercial |
$111.97
|
| Rate for Payer: Humana Commercial |
$100.18
|
| Rate for Payer: Humana KY Medicaid |
$40.53
|
| Rate for Payer: Kentucky WC Medicaid |
$40.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.72
|
| Rate for Payer: Ohio Health Group HMO |
$88.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.54
|
| Rate for Payer: PHCS Commercial |
$113.15
|
| Rate for Payer: United Healthcare All Payer |
$103.72
|
|
|
NORFLEX 60MG/2ML INJECTION
|
Facility
|
IP
|
$122.60
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
25002276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$117.70 |
| Rate for Payer: Aetna Commercial |
$94.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.63
|
| Rate for Payer: Cash Price |
$61.30
|
| Rate for Payer: Cigna Commercial |
$101.76
|
| Rate for Payer: First Health Commercial |
$116.47
|
| Rate for Payer: Humana Commercial |
$104.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.89
|
| Rate for Payer: Ohio Health Group HMO |
$91.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.01
|
| Rate for Payer: PHCS Commercial |
$117.70
|
| Rate for Payer: United Healthcare All Payer |
$107.89
|
|
