|
ATRICULEZE M HEAD 36MM +12
|
Facility
|
IP
|
$6,588.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.53 |
| Max. Negotiated Rate |
$6,325.15 |
| Rate for Payer: Aetna Commercial |
$5,073.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,139.19
|
| Rate for Payer: Cash Price |
$3,294.35
|
| Rate for Payer: Cigna Commercial |
$5,468.62
|
| Rate for Payer: First Health Commercial |
$6,259.26
|
| Rate for Payer: Humana Commercial |
$5,600.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,402.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,862.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,976.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,798.06
|
| Rate for Payer: Ohio Health Group HMO |
$4,941.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,317.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,042.50
|
| Rate for Payer: PHCS Commercial |
$6,325.15
|
| Rate for Payer: United Healthcare All Payer |
$5,798.06
|
|
|
ATRICULEZE M HEAD 36MM +15.5
|
Facility
|
IP
|
$5,667.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$736.72 |
| Max. Negotiated Rate |
$5,440.42 |
| Rate for Payer: Aetna Commercial |
$4,363.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,420.34
|
| Rate for Payer: Cash Price |
$2,833.55
|
| Rate for Payer: Cigna Commercial |
$4,703.69
|
| Rate for Payer: First Health Commercial |
$5,383.74
|
| Rate for Payer: Humana Commercial |
$4,817.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,647.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,182.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,700.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,987.05
|
| Rate for Payer: Ohio Health Group HMO |
$4,250.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,133.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,756.80
|
| Rate for Payer: PHCS Commercial |
$5,440.42
|
| Rate for Payer: United Healthcare All Payer |
$4,987.05
|
|
|
ATRICULEZE M HEAD 36MM +15.5
|
Facility
|
OP
|
$5,667.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$736.72 |
| Max. Negotiated Rate |
$5,440.42 |
| Rate for Payer: Aetna Commercial |
$4,363.67
|
| Rate for Payer: Anthem Medicaid |
$1,948.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,420.34
|
| Rate for Payer: Cash Price |
$2,833.55
|
| Rate for Payer: Cigna Commercial |
$4,703.69
|
| Rate for Payer: First Health Commercial |
$5,383.74
|
| Rate for Payer: Humana Commercial |
$4,817.04
|
| Rate for Payer: Humana KY Medicaid |
$1,948.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,968.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,647.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,182.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,700.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,988.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,987.05
|
| Rate for Payer: Ohio Health Group HMO |
$4,250.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,133.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,756.80
|
| Rate for Payer: PHCS Commercial |
$5,440.42
|
| Rate for Payer: United Healthcare All Payer |
$4,987.05
|
|
|
ATRICULEZE M HEAD 36MM +8.5
|
Facility
|
IP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
ATRICULEZE M HEAD 36MM +8.5
|
Facility
|
OP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Anthem Medicaid |
$1,569.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Humana KY Medicaid |
$1,569.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,585.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,600.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
ATRIPLA TABLET
|
Facility
|
OP
|
$171.82
|
|
|
Service Code
|
NDC 15584010101
|
| Hospital Charge Code |
25000279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$164.95 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Anthem Medicaid |
$59.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.02
|
| Rate for Payer: Cash Price |
$85.91
|
| Rate for Payer: Cigna Commercial |
$142.61
|
| Rate for Payer: First Health Commercial |
$163.23
|
| Rate for Payer: Humana Commercial |
$146.05
|
| Rate for Payer: Humana KY Medicaid |
$59.09
|
| Rate for Payer: Kentucky WC Medicaid |
$59.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.20
|
| Rate for Payer: Ohio Health Group HMO |
$128.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.26
|
| Rate for Payer: PHCS Commercial |
$164.95
|
| Rate for Payer: United Healthcare All Payer |
$151.20
|
|
|
ATRIPLA TABLET
|
Facility
|
IP
|
$171.82
|
|
|
Service Code
|
NDC 15584010101
|
| Hospital Charge Code |
25000279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$164.95 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.02
|
| Rate for Payer: Cash Price |
$85.91
|
| Rate for Payer: Cigna Commercial |
$142.61
|
| Rate for Payer: First Health Commercial |
$163.23
|
| Rate for Payer: Humana Commercial |
$146.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.20
|
| Rate for Payer: Ohio Health Group HMO |
$128.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.26
|
| Rate for Payer: PHCS Commercial |
$164.95
|
| Rate for Payer: United Healthcare All Payer |
$151.20
|
|
|
ATROPINE 0.01MG(0.25MG/5ML)SYR
|
Facility
|
IP
|
$127.38
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001880
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$122.28 |
| Rate for Payer: Aetna Commercial |
$98.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.36
|
| Rate for Payer: Cash Price |
$63.69
|
| Rate for Payer: Cigna Commercial |
$105.73
|
| Rate for Payer: First Health Commercial |
$121.01
|
| Rate for Payer: Humana Commercial |
$108.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.09
|
| Rate for Payer: Ohio Health Group HMO |
$95.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.49
|
| Rate for Payer: PHCS Commercial |
$122.28
|
| Rate for Payer: United Healthcare All Payer |
$112.09
|
|
|
ATROPINE 0.01MG(0.25MG/5ML)SYR
|
Facility
|
OP
|
$127.38
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001880
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$122.28 |
| Rate for Payer: Aetna Commercial |
$98.08
|
| Rate for Payer: Anthem Medicaid |
$43.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.36
|
| Rate for Payer: Cash Price |
$63.69
|
| Rate for Payer: Cigna Commercial |
$105.73
|
| Rate for Payer: First Health Commercial |
$121.01
|
| Rate for Payer: Humana Commercial |
$108.27
|
| Rate for Payer: Humana KY Medicaid |
$43.81
|
| Rate for Payer: Kentucky WC Medicaid |
$44.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.09
|
| Rate for Payer: Ohio Health Group HMO |
$95.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.49
|
| Rate for Payer: PHCS Commercial |
$122.28
|
| Rate for Payer: United Healthcare All Payer |
$112.09
|
|
|
ATROPINE 0.01MG(1 MG/10 ML)SYR
|
Facility
|
IP
|
$115.49
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$110.87 |
| Rate for Payer: Humana Commercial |
$98.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.63
|
| Rate for Payer: Ohio Health Group HMO |
$86.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.80
|
| Rate for Payer: PHCS Commercial |
$110.87
|
| Rate for Payer: United Healthcare All Payer |
$101.63
|
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.08
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cigna Commercial |
$95.86
|
| Rate for Payer: First Health Commercial |
$109.72
|
|
|
ATROPINE 0.01MG(1 MG/10 ML)SYR
|
Facility
|
OP
|
$115.49
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$110.87 |
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: Anthem Medicaid |
$39.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.08
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cigna Commercial |
$95.86
|
| Rate for Payer: First Health Commercial |
$109.72
|
| Rate for Payer: Humana Commercial |
$98.17
|
| Rate for Payer: Humana KY Medicaid |
$39.72
|
| Rate for Payer: Kentucky WC Medicaid |
$40.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.63
|
| Rate for Payer: Ohio Health Group HMO |
$86.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.80
|
| Rate for Payer: PHCS Commercial |
$110.87
|
| Rate for Payer: United Healthcare All Payer |
$101.63
|
|
|
ATROPINE 0.5 MG/5 ML SYRINGE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25004053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem Medicaid |
$39.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.48
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Humana KY Medicaid |
$39.89
|
| Rate for Payer: Kentucky WC Medicaid |
$40.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
ATROPINE 0.5 MG/5 ML SYRINGE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25004053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.48
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
ATROPINE 1% EYE DROPS
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
NDC 60219174802
|
| Hospital Charge Code |
25002855
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
ATROPINE 1% EYE DROPS
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
NDC 60219174802
|
| Hospital Charge Code |
25002855
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
ATROPINE 1% EYE DROPS 5ML
|
Facility
|
IP
|
$1.95
|
|
|
Service Code
|
NDC 60219174903
|
| Hospital Charge Code |
25002857
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.52
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna Commercial |
$1.62
|
| Rate for Payer: First Health Commercial |
$1.85
|
| Rate for Payer: Humana Commercial |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.72
|
| Rate for Payer: Ohio Health Group HMO |
$1.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.60
|
| Rate for Payer: PHCS Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Payer |
$1.72
|
|
|
ATROPINE 1% EYE DROPS 5ML
|
Facility
|
OP
|
$1.95
|
|
|
Service Code
|
NDC 60219174903
|
| Hospital Charge Code |
25002857
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Anthem Medicaid |
$0.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.52
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna Commercial |
$1.62
|
| Rate for Payer: First Health Commercial |
$1.85
|
| Rate for Payer: Humana Commercial |
$1.66
|
| Rate for Payer: Humana KY Medicaid |
$0.67
|
| Rate for Payer: Kentucky WC Medicaid |
$0.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.72
|
| Rate for Payer: Ohio Health Group HMO |
$1.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.60
|
| Rate for Payer: PHCS Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Payer |
$1.72
|
|
|
ATROPINE RT 0.01MG (0.4MG/ML)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001883
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
ATROPINE RT 0.01MG (0.4MG/ML)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001883
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$39.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$39.55
|
| Rate for Payer: Kentucky WC Medicaid |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
ATROPINE RT 0.01 MG[1MG/ML VL]
|
Facility
|
IP
|
$119.56
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001882
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$114.78 |
| Rate for Payer: Aetna Commercial |
$92.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.26
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cigna Commercial |
$99.23
|
| Rate for Payer: First Health Commercial |
$113.58
|
| Rate for Payer: Humana Commercial |
$101.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.21
|
| Rate for Payer: Ohio Health Group HMO |
$89.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.06
|
| Rate for Payer: PHCS Commercial |
$114.78
|
| Rate for Payer: United Healthcare All Payer |
$105.21
|
|
|
ATROPINE RT 0.01 MG[1MG/ML VL]
|
Facility
|
OP
|
$119.56
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001882
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$114.78 |
| Rate for Payer: Aetna Commercial |
$92.06
|
| Rate for Payer: Anthem Medicaid |
$41.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.26
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cigna Commercial |
$99.23
|
| Rate for Payer: First Health Commercial |
$113.58
|
| Rate for Payer: Humana Commercial |
$101.63
|
| Rate for Payer: Humana KY Medicaid |
$41.12
|
| Rate for Payer: Kentucky WC Medicaid |
$41.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.21
|
| Rate for Payer: Ohio Health Group HMO |
$89.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.06
|
| Rate for Payer: PHCS Commercial |
$114.78
|
| Rate for Payer: United Healthcare All Payer |
$105.21
|
|
|
ATROVENT (IPRATOPIUM) 15ML
|
Facility
|
IP
|
$1.14
|
|
|
Service Code
|
NDC 24208039915
|
| Hospital Charge Code |
25000280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.89
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna Commercial |
$0.95
|
| Rate for Payer: First Health Commercial |
$1.08
|
| Rate for Payer: Humana Commercial |
$0.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.00
|
| Rate for Payer: Ohio Health Group HMO |
$0.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.35
|
| Rate for Payer: PHCS Commercial |
$1.09
|
| Rate for Payer: United Healthcare All Payer |
$1.00
|
|
|
ATROVENT (IPRATOPIUM) 15ML
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
NDC 24208039915
|
| Hospital Charge Code |
25000280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Anthem Medicaid |
$0.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.89
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna Commercial |
$0.95
|
| Rate for Payer: First Health Commercial |
$1.08
|
| Rate for Payer: Humana Commercial |
$0.97
|
| Rate for Payer: Humana KY Medicaid |
$0.39
|
| Rate for Payer: Kentucky WC Medicaid |
$0.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.00
|
| Rate for Payer: Ohio Health Group HMO |
$0.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.35
|
| Rate for Payer: PHCS Commercial |
$1.09
|
| Rate for Payer: United Healthcare All Payer |
$1.00
|
|
|
ATROVENT(IPRATR)HFAINH12.90GM
|
Facility
|
IP
|
$1,077.06
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25000282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$1,033.98 |
| Rate for Payer: Aetna Commercial |
$829.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.11
|
| Rate for Payer: Cash Price |
$538.53
|
| Rate for Payer: Cigna Commercial |
$893.96
|
| Rate for Payer: First Health Commercial |
$1,023.21
|
| Rate for Payer: Humana Commercial |
$915.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$794.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$947.81
|
| Rate for Payer: Ohio Health Group HMO |
$807.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.89
|
| Rate for Payer: PHCS Commercial |
$1,033.98
|
| Rate for Payer: United Healthcare All Payer |
$947.81
|
|
|
ATROVENT(IPRATR)HFAINH12.90GM
|
Facility
|
OP
|
$1,077.06
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25000282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$1,033.98 |
| Rate for Payer: Aetna Commercial |
$829.34
|
| Rate for Payer: Anthem Medicaid |
$370.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.11
|
| Rate for Payer: Cash Price |
$538.53
|
| Rate for Payer: Cigna Commercial |
$893.96
|
| Rate for Payer: First Health Commercial |
$1,023.21
|
| Rate for Payer: Humana Commercial |
$915.50
|
| Rate for Payer: Humana KY Medicaid |
$370.40
|
| Rate for Payer: Kentucky WC Medicaid |
$374.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$794.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$377.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$947.81
|
| Rate for Payer: Ohio Health Group HMO |
$807.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.89
|
| Rate for Payer: PHCS Commercial |
$1,033.98
|
| Rate for Payer: United Healthcare All Payer |
$947.81
|
|
