|
ASTELIN NASAL SPRAY 137MCG
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 60505083305
|
| Hospital Charge Code |
25000270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna Commercial |
$0.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.37
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna Commercial |
$0.40
|
| Rate for Payer: First Health Commercial |
$0.46
|
| Rate for Payer: Humana Commercial |
$0.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.42
|
| Rate for Payer: Ohio Health Group HMO |
$0.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.15
|
| Rate for Payer: PHCS Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Payer |
$0.42
|
|
|
AS TIBIA OFFSET STEM 015*92MM
|
Facility
|
OP
|
$16,537.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,149.84 |
| Max. Negotiated Rate |
$15,875.71 |
| Rate for Payer: Anthem Medicaid |
$5,687.14
|
| Rate for Payer: Aetna Commercial |
$12,733.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,899.02
|
| Rate for Payer: Cash Price |
$8,268.60
|
| Rate for Payer: Cigna Commercial |
$13,725.88
|
| Rate for Payer: First Health Commercial |
$15,710.34
|
| Rate for Payer: Humana Commercial |
$14,056.62
|
| Rate for Payer: Humana KY Medicaid |
$5,687.14
|
| Rate for Payer: Kentucky WC Medicaid |
$5,745.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,560.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,204.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,961.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,801.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,552.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,402.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,307.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,149.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,126.53
|
| Rate for Payer: PHCS Commercial |
$15,875.71
|
| Rate for Payer: United Healthcare All Payer |
$14,552.74
|
|
|
AS TIBIA OFFSET STEM 015*92MM
|
Facility
|
IP
|
$16,537.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,149.84 |
| Max. Negotiated Rate |
$15,875.71 |
| Rate for Payer: Aetna Commercial |
$12,733.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,899.02
|
| Rate for Payer: Cash Price |
$8,268.60
|
| Rate for Payer: Cigna Commercial |
$13,725.88
|
| Rate for Payer: First Health Commercial |
$15,710.34
|
| Rate for Payer: Humana Commercial |
$14,056.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,560.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,204.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,961.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,552.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,402.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,307.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,149.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,126.53
|
| Rate for Payer: PHCS Commercial |
$15,875.71
|
| Rate for Payer: United Healthcare All Payer |
$14,552.74
|
|
|
AS TIBIA OFFSET STEM 016*92MM
|
Facility
|
IP
|
$17,682.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.66 |
| Max. Negotiated Rate |
$16,974.72 |
| Rate for Payer: Aetna Commercial |
$13,615.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,791.96
|
| Rate for Payer: Cash Price |
$8,841.00
|
| Rate for Payer: Cigna Commercial |
$14,676.06
|
| Rate for Payer: First Health Commercial |
$16,797.90
|
| Rate for Payer: Humana Commercial |
$15,029.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,499.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,049.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,304.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,560.16
|
| Rate for Payer: Ohio Health Group HMO |
$13,261.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,536.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,481.42
|
| Rate for Payer: PHCS Commercial |
$16,974.72
|
| Rate for Payer: United Healthcare All Payer |
$15,560.16
|
|
|
AS TIBIA OFFSET STEM 016*92MM
|
Facility
|
OP
|
$17,682.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,298.66 |
| Max. Negotiated Rate |
$16,974.72 |
| Rate for Payer: Aetna Commercial |
$13,615.14
|
| Rate for Payer: Anthem Medicaid |
$6,080.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,791.96
|
| Rate for Payer: Cash Price |
$8,841.00
|
| Rate for Payer: Cigna Commercial |
$14,676.06
|
| Rate for Payer: First Health Commercial |
$16,797.90
|
| Rate for Payer: Humana Commercial |
$15,029.70
|
| Rate for Payer: Humana KY Medicaid |
$6,080.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,142.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,499.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,049.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,304.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,202.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,560.16
|
| Rate for Payer: Ohio Health Group HMO |
$13,261.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,536.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,481.42
|
| Rate for Payer: PHCS Commercial |
$16,974.72
|
| Rate for Payer: United Healthcare All Payer |
$15,560.16
|
|
|
ATACAN(CANDESARTCILEXETIL)4MGT
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
NDC 49884065809
|
| Hospital Charge Code |
25000272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Anthem Medicaid |
$3.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.07
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cigna Commercial |
$8.59
|
| Rate for Payer: First Health Commercial |
$9.83
|
| Rate for Payer: Humana Commercial |
$8.80
|
| Rate for Payer: Humana KY Medicaid |
$3.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.11
|
| Rate for Payer: Ohio Health Group HMO |
$7.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.21
|
| Rate for Payer: PHCS Commercial |
$9.94
|
| Rate for Payer: United Healthcare All Payer |
$9.11
|
|
|
ATACAN(CANDESARTCILEXETIL)4MGT
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
NDC 49884065809
|
| Hospital Charge Code |
25000272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.07
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cigna Commercial |
$8.59
|
| Rate for Payer: First Health Commercial |
$9.83
|
| Rate for Payer: Humana Commercial |
$8.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.11
|
| Rate for Payer: Ohio Health Group HMO |
$7.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.21
|
| Rate for Payer: PHCS Commercial |
$9.94
|
| Rate for Payer: United Healthcare All Payer |
$9.11
|
|
|
ATACAND (CANDESARTAN) 16MG TAB
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
NDC 49884066009
|
| Hospital Charge Code |
25000273
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.07
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cigna Commercial |
$8.59
|
| Rate for Payer: First Health Commercial |
$9.83
|
| Rate for Payer: Humana Commercial |
$8.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.11
|
| Rate for Payer: Ohio Health Group HMO |
$7.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.21
|
| Rate for Payer: PHCS Commercial |
$9.94
|
| Rate for Payer: United Healthcare All Payer |
$9.11
|
|
|
ATACAND (CANDESARTAN) 16MG TAB
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
NDC 49884066009
|
| Hospital Charge Code |
25000273
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Anthem Medicaid |
$3.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.07
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cigna Commercial |
$8.59
|
| Rate for Payer: First Health Commercial |
$9.83
|
| Rate for Payer: Humana Commercial |
$8.80
|
| Rate for Payer: Humana KY Medicaid |
$3.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.11
|
| Rate for Payer: Ohio Health Group HMO |
$7.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.21
|
| Rate for Payer: PHCS Commercial |
$9.94
|
| Rate for Payer: United Healthcare All Payer |
$9.11
|
|
|
ATARAX (HYDROXYZINE 10MG/1TAB
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 60687066401
|
| Hospital Charge Code |
25000274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
ATARAX (HYDROXYZINE 10MG/1TAB
|
Facility
|
IP
|
$4.47
|
|
|
Service Code
|
NDC 60687066401
|
| Hospital Charge Code |
25000274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
ATARAX (HYDROXYZINE) 10MG/5ML
|
Facility
|
OP
|
$9.02
|
|
|
Service Code
|
NDC 54838050280
|
| Hospital Charge Code |
25000276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Aetna Commercial |
$6.95
|
| Rate for Payer: Anthem Medicaid |
$3.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.04
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cigna Commercial |
$7.49
|
| Rate for Payer: First Health Commercial |
$8.57
|
| Rate for Payer: Humana Commercial |
$7.67
|
| Rate for Payer: Humana KY Medicaid |
$3.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.94
|
| Rate for Payer: Ohio Health Group HMO |
$6.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.80
|
| Rate for Payer: PHCS Commercial |
$8.66
|
| Rate for Payer: United Healthcare All Payer |
$7.94
|
|
|
ATARAX (HYDROXYZINE) 10MG/5ML
|
Facility
|
IP
|
$9.02
|
|
|
Service Code
|
NDC 54838050280
|
| Hospital Charge Code |
25000276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Aetna Commercial |
$6.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.04
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cigna Commercial |
$7.49
|
| Rate for Payer: First Health Commercial |
$8.57
|
| Rate for Payer: Humana Commercial |
$7.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.94
|
| Rate for Payer: Ohio Health Group HMO |
$6.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.80
|
| Rate for Payer: PHCS Commercial |
$8.66
|
| Rate for Payer: United Healthcare All Payer |
$7.94
|
|
|
ATARAX (HYDROXYZINE 25MG/1TAB
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 60687067501
|
| Hospital Charge Code |
25000275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
ATARAX (HYDROXYZINE 25MG/1TAB
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 60687067501
|
| Hospital Charge Code |
25000275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
A-TEAM
|
Professional
|
Both
|
$105.00
|
|
| Hospital Charge Code |
22200122
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$105.00
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Multiplan PHCS |
$63.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$73.50
|
| Rate for Payer: UHCCP Medicaid |
$36.75
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
|
IP
|
$13,114.85
|
|
|
Service Code
|
MSDRG 302
|
| Min. Negotiated Rate |
$8,899.36 |
| Max. Negotiated Rate |
$13,114.85 |
| Rate for Payer: Anthem Medicaid |
$8,899.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,367.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,114.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,646.46
|
| Rate for Payer: Humana KY Medicaid |
$8,899.36
|
| Rate for Payer: Humana Medicare Advantage |
$9,367.75
|
| Rate for Payer: Kentucky WC Medicaid |
$8,988.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,241.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,077.35
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
|
IP
|
$7,698.59
|
|
|
Service Code
|
MSDRG 303
|
| Min. Negotiated Rate |
$5,224.04 |
| Max. Negotiated Rate |
$7,698.59 |
| Rate for Payer: Anthem Medicaid |
$5,224.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,498.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,698.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,423.64
|
| Rate for Payer: Humana KY Medicaid |
$5,224.04
|
| Rate for Payer: Humana Medicare Advantage |
$5,498.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,276.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,598.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,328.52
|
|
|
ATHROTOMY METATARSOPHALANGEAL
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 28022
|
| Hospital Charge Code |
76102641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
ATHROTOMY METATARSOPHALANGEAL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 28022
|
| Hospital Charge Code |
761P2641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.29 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Aetna Commercial |
$499.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.29
|
| Rate for Payer: Anthem Medicaid |
$173.68
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$674.32
|
| Rate for Payer: Healthspan PPO |
$594.14
|
| Rate for Payer: Humana Medicaid |
$173.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$399.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.15
|
| Rate for Payer: Molina Healthcare Passport |
$173.68
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$174.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.42
|
|
|
ATHROTOMY METATARSOPHALANGEAL
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 28022
|
| Hospital Charge Code |
76102641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$338.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
ATHROTOMY METATARSOPHALANGEAL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
76102641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.53 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$84.53
|
| Rate for Payer: Anthem Medicaid |
$125.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$194.78
|
| Rate for Payer: Healthspan PPO |
$843.03
|
| Rate for Payer: Humana Medicaid |
$125.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$141.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.30
|
| Rate for Payer: Molina Healthcare Passport |
$125.78
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$88.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.04
|
|
|
ATIVAN 2MG/ML VL GTT
|
Facility
|
IP
|
$76.29
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
25002219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$58.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.51
|
| Rate for Payer: Cash Price |
$38.15
|
| Rate for Payer: Cigna Commercial |
$63.32
|
| Rate for Payer: First Health Commercial |
$72.48
|
| Rate for Payer: Humana Commercial |
$64.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.14
|
| Rate for Payer: Ohio Health Group HMO |
$57.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.65
|
| Rate for Payer: PHCS Commercial |
$73.24
|
| Rate for Payer: United Healthcare All Payer |
$67.14
|
|
|
ATIVAN 2MG/ML VL GTT
|
Facility
|
OP
|
$76.29
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
25002219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$58.74
|
| Rate for Payer: Anthem Medicaid |
$26.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.51
|
| Rate for Payer: Cash Price |
$38.15
|
| Rate for Payer: Cigna Commercial |
$63.32
|
| Rate for Payer: First Health Commercial |
$72.48
|
| Rate for Payer: Humana Commercial |
$64.85
|
| Rate for Payer: Humana KY Medicaid |
$26.24
|
| Rate for Payer: Kentucky WC Medicaid |
$26.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.14
|
| Rate for Payer: Ohio Health Group HMO |
$57.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.65
|
| Rate for Payer: PHCS Commercial |
$73.24
|
| Rate for Payer: United Healthcare All Payer |
$67.14
|
|
|
ATIVAN (LORAZEPAM) 2MG/1ML
|
Facility
|
OP
|
$76.29
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
25002218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$58.74
|
| Rate for Payer: Anthem Medicaid |
$26.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.51
|
| Rate for Payer: Cash Price |
$38.15
|
| Rate for Payer: Cigna Commercial |
$63.32
|
| Rate for Payer: First Health Commercial |
$72.48
|
| Rate for Payer: Humana Commercial |
$64.85
|
| Rate for Payer: Humana KY Medicaid |
$26.24
|
| Rate for Payer: Kentucky WC Medicaid |
$26.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.14
|
| Rate for Payer: Ohio Health Group HMO |
$57.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.65
|
| Rate for Payer: PHCS Commercial |
$73.24
|
| Rate for Payer: United Healthcare All Payer |
$67.14
|
|
