|
QUANTITATIVE SURGICAL CULTURE
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
30001254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem Medicaid |
$9.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.89
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Humana KY Medicaid |
$9.89
|
| Rate for Payer: Humana Medicare Advantage |
$9.89
|
| Rate for Payer: Kentucky WC Medicaid |
$9.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.79
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
QUANTITATIVE SURGICAL CULTURE
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
30001254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.53
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.79
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
QUESTRAN LIGHT(CHOLESTYRAM 4GM
|
Facility
|
OP
|
$10.05
|
|
|
Service Code
|
NDC 245003660
|
| Hospital Charge Code |
25001281
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Anthem Medicaid |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.84
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cigna Commercial |
$8.34
|
| Rate for Payer: First Health Commercial |
$9.55
|
| Rate for Payer: Humana Commercial |
$8.54
|
| Rate for Payer: Humana KY Medicaid |
$3.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.84
|
| Rate for Payer: Ohio Health Group HMO |
$7.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$9.65
|
| Rate for Payer: United Healthcare All Payer |
$8.84
|
|
|
QUESTRAN LIGHT(CHOLESTYRAM 4GM
|
Facility
|
IP
|
$10.05
|
|
|
Service Code
|
NDC 245003660
|
| Hospital Charge Code |
25001281
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.84
|
| Rate for Payer: Cash Price |
$5.03
|
| Rate for Payer: Cigna Commercial |
$8.34
|
| Rate for Payer: First Health Commercial |
$9.55
|
| Rate for Payer: Humana Commercial |
$8.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.84
|
| Rate for Payer: Ohio Health Group HMO |
$7.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$9.65
|
| Rate for Payer: United Healthcare All Payer |
$8.84
|
|
|
QUICKANCHOR PLUS 2/0 ETHIBOND
|
Facility
|
OP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem Medicaid |
$1,070.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Humana KY Medicaid |
$1,070.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,081.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,092.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
QUICKANCHOR PLUS 2/0 ETHIBOND
|
Facility
|
IP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
QUICKANCHOR PLUS W/#2 ETHIBOND
|
Facility
|
IP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
QUICKANCHOR PLUS W/#2 ETHIBOND
|
Facility
|
OP
|
$3,113.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.76 |
| Max. Negotiated Rate |
$2,988.96 |
| Rate for Payer: Aetna Commercial |
$2,397.40
|
| Rate for Payer: Anthem Medicaid |
$1,070.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,428.53
|
| Rate for Payer: Cash Price |
$1,556.75
|
| Rate for Payer: Cigna Commercial |
$2,584.20
|
| Rate for Payer: First Health Commercial |
$2,957.82
|
| Rate for Payer: Humana Commercial |
$2,646.48
|
| Rate for Payer: Humana KY Medicaid |
$1,070.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,081.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,553.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,297.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,092.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,739.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,335.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.18
|
| Rate for Payer: PHCS Commercial |
$2,988.96
|
| Rate for Payer: United Healthcare All Payer |
$2,739.88
|
|
|
QUICK CROSS GC .014 135C
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
QUICK CROSS GC .014 135C
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
QUINAGLUTE (QUIN. G 324MG/1TAB
|
Facility
|
IP
|
$24.25
|
|
|
Service Code
|
NDC 53489014101
|
| Hospital Charge Code |
25001282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.92
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cigna Commercial |
$20.13
|
| Rate for Payer: First Health Commercial |
$23.04
|
| Rate for Payer: Humana Commercial |
$20.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.34
|
| Rate for Payer: Ohio Health Group HMO |
$18.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.52
|
| Rate for Payer: PHCS Commercial |
$23.28
|
| Rate for Payer: United Healthcare All Payer |
$21.34
|
|
|
QUINAGLUTE (QUIN. G 324MG/1TAB
|
Facility
|
OP
|
$24.25
|
|
|
Service Code
|
NDC 53489014101
|
| Hospital Charge Code |
25001282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Anthem Medicaid |
$8.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.92
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cigna Commercial |
$20.13
|
| Rate for Payer: First Health Commercial |
$23.04
|
| Rate for Payer: Humana Commercial |
$20.61
|
| Rate for Payer: Humana KY Medicaid |
$8.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.34
|
| Rate for Payer: Ohio Health Group HMO |
$18.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.52
|
| Rate for Payer: PHCS Commercial |
$23.28
|
| Rate for Payer: United Healthcare All Payer |
$21.34
|
|
|
QUINIDINE SULFATE 200MG/1TAB
|
Facility
|
OP
|
$29.07
|
|
|
Service Code
|
NDC 42806051330
|
| Hospital Charge Code |
25003867
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$27.91 |
| Rate for Payer: Aetna Commercial |
$22.38
|
| Rate for Payer: Anthem Medicaid |
$10.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.67
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cigna Commercial |
$24.13
|
| Rate for Payer: First Health Commercial |
$27.62
|
| Rate for Payer: Humana Commercial |
$24.71
|
| Rate for Payer: Humana KY Medicaid |
$10.00
|
| Rate for Payer: Kentucky WC Medicaid |
$10.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.58
|
| Rate for Payer: Ohio Health Group HMO |
$21.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.01
|
| Rate for Payer: PHCS Commercial |
$27.91
|
| Rate for Payer: United Healthcare All Payer |
$25.58
|
|
|
QUINIDINE SULFATE 200MG/1TAB
|
Facility
|
IP
|
$29.07
|
|
|
Service Code
|
NDC 42806051330
|
| Hospital Charge Code |
25003867
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$27.91 |
| Rate for Payer: Aetna Commercial |
$22.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.67
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cigna Commercial |
$24.13
|
| Rate for Payer: First Health Commercial |
$27.62
|
| Rate for Payer: Humana Commercial |
$24.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.58
|
| Rate for Payer: Ohio Health Group HMO |
$21.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.01
|
| Rate for Payer: PHCS Commercial |
$27.91
|
| Rate for Payer: United Healthcare All Payer |
$25.58
|
|
|
QUINIDINE SULFATE 300MG/1TAB
|
Facility
|
IP
|
$29.72
|
|
|
Service Code
|
NDC 42806051230
|
| Hospital Charge Code |
25003868
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$28.53 |
| Rate for Payer: Aetna Commercial |
$22.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.18
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna Commercial |
$24.67
|
| Rate for Payer: First Health Commercial |
$28.23
|
| Rate for Payer: Humana Commercial |
$25.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.15
|
| Rate for Payer: Ohio Health Group HMO |
$22.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.21
|
| Rate for Payer: PHCS Commercial |
$28.53
|
| Rate for Payer: United Healthcare All Payer |
$26.15
|
|
|
QUINIDINE SULFATE 300MG/1TAB
|
Facility
|
OP
|
$29.72
|
|
|
Service Code
|
NDC 42806051230
|
| Hospital Charge Code |
25003868
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$28.53 |
| Rate for Payer: Aetna Commercial |
$22.88
|
| Rate for Payer: Anthem Medicaid |
$10.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.18
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cigna Commercial |
$24.67
|
| Rate for Payer: First Health Commercial |
$28.23
|
| Rate for Payer: Humana Commercial |
$25.26
|
| Rate for Payer: Humana KY Medicaid |
$10.22
|
| Rate for Payer: Kentucky WC Medicaid |
$10.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.15
|
| Rate for Payer: Ohio Health Group HMO |
$22.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.21
|
| Rate for Payer: PHCS Commercial |
$28.53
|
| Rate for Payer: United Healthcare All Payer |
$26.15
|
|
|
Q-VAR 40MCG INHALER 10.6 GM
|
Facility
|
OP
|
$5.26
|
|
|
Service Code
|
NDC 59310030240
|
| Hospital Charge Code |
25001285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Anthem Medicaid |
$1.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.10
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cigna Commercial |
$4.37
|
| Rate for Payer: First Health Commercial |
$5.00
|
| Rate for Payer: Humana Commercial |
$4.47
|
| Rate for Payer: Humana KY Medicaid |
$1.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.63
|
| Rate for Payer: Ohio Health Group HMO |
$3.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.63
|
| Rate for Payer: PHCS Commercial |
$5.05
|
| Rate for Payer: United Healthcare All Payer |
$4.63
|
|
|
Q-VAR 40MCG INHALER 10.6 GM
|
Facility
|
IP
|
$5.26
|
|
|
Service Code
|
NDC 59310030240
|
| Hospital Charge Code |
25001285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.10
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cigna Commercial |
$4.37
|
| Rate for Payer: First Health Commercial |
$5.00
|
| Rate for Payer: Humana Commercial |
$4.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.63
|
| Rate for Payer: Ohio Health Group HMO |
$3.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.63
|
| Rate for Payer: PHCS Commercial |
$5.05
|
| Rate for Payer: United Healthcare All Payer |
$4.63
|
|
|
Q-VAR 80MCG INHALER
|
Facility
|
IP
|
$7.43
|
|
|
Service Code
|
NDC 59310030480
|
| Hospital Charge Code |
25003397
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.80
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna Commercial |
$6.17
|
| Rate for Payer: First Health Commercial |
$7.06
|
| Rate for Payer: Humana Commercial |
$6.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.54
|
| Rate for Payer: Ohio Health Group HMO |
$5.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.30
|
| Rate for Payer: PHCS Commercial |
$7.13
|
| Rate for Payer: United Healthcare All Payer |
$6.54
|
|
|
Q-VAR 80MCG INHALER
|
Facility
|
OP
|
$7.43
|
|
|
Service Code
|
NDC 59310030480
|
| Hospital Charge Code |
25003397
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Anthem Medicaid |
$2.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.80
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cigna Commercial |
$6.17
|
| Rate for Payer: First Health Commercial |
$7.06
|
| Rate for Payer: Humana Commercial |
$6.32
|
| Rate for Payer: Humana KY Medicaid |
$2.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6.54
|
| Rate for Payer: Ohio Health Group HMO |
$5.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.30
|
| Rate for Payer: PHCS Commercial |
$7.13
|
| Rate for Payer: United Healthcare All Payer |
$6.54
|
|
|
R3 0^+4 XLPE ACET LINER 28*46
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
R3 0^+4 XLPE ACET LINER 28*46
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
R3 0^+4 XLPE ACET LINER 28*48
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
R3 0^+4 XLPE ACET LINER 28*48
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
R3 0^+4 XLPE ACET LINER 28*50
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
