|
BENTYL (DICYCLOMINE) 20MG/2ML
|
Facility
|
OP
|
$353.06
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
25001887
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$338.94 |
| Rate for Payer: Aetna Commercial |
$271.86
|
| Rate for Payer: Anthem Medicaid |
$121.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$275.39
|
| Rate for Payer: Cash Price |
$176.53
|
| Rate for Payer: Cigna Commercial |
$293.04
|
| Rate for Payer: First Health Commercial |
$335.41
|
| Rate for Payer: Humana Commercial |
$300.10
|
| Rate for Payer: Humana KY Medicaid |
$121.42
|
| Rate for Payer: Kentucky WC Medicaid |
$122.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$289.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$260.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$310.69
|
| Rate for Payer: Ohio Health Group HMO |
$264.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.45
|
| Rate for Payer: PHCS Commercial |
$338.94
|
| Rate for Payer: United Healthcare All Payer |
$310.69
|
|
|
BERMUDA GRASS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000816
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
BERMUDA GRASS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000816
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
BESIVANCE 0.6% 5ML (PER DROP)
|
Facility
|
IP
|
$10.27
|
|
|
Service Code
|
NDC 24208044605
|
| Hospital Charge Code |
25000327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$9.86 |
| Rate for Payer: Aetna Commercial |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.01
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cigna Commercial |
$8.52
|
| Rate for Payer: First Health Commercial |
$9.76
|
| Rate for Payer: Humana Commercial |
$8.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.04
|
| Rate for Payer: Ohio Health Group HMO |
$7.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$9.86
|
| Rate for Payer: United Healthcare All Payer |
$9.04
|
|
|
BESIVANCE 0.6% 5ML (PER DROP)
|
Facility
|
OP
|
$10.27
|
|
|
Service Code
|
NDC 24208044605
|
| Hospital Charge Code |
25000327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$9.86 |
| Rate for Payer: Aetna Commercial |
$7.91
|
| Rate for Payer: Anthem Medicaid |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.01
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Cigna Commercial |
$8.52
|
| Rate for Payer: First Health Commercial |
$9.76
|
| Rate for Payer: Humana Commercial |
$8.73
|
| Rate for Payer: Humana KY Medicaid |
$3.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.04
|
| Rate for Payer: Ohio Health Group HMO |
$7.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$9.86
|
| Rate for Payer: United Healthcare All Payer |
$9.04
|
|
|
BETADINE 0.35% 1,000ML LAVAGE
|
Facility
|
IP
|
$325.49
|
|
|
Service Code
|
NDC 65041130
|
| Hospital Charge Code |
25003740
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$312.47 |
| Rate for Payer: Aetna Commercial |
$250.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.88
|
| Rate for Payer: Cash Price |
$162.74
|
| Rate for Payer: Cigna Commercial |
$270.16
|
| Rate for Payer: First Health Commercial |
$309.22
|
| Rate for Payer: Humana Commercial |
$276.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$240.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.43
|
| Rate for Payer: Ohio Health Group HMO |
$244.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.90
|
| Rate for Payer: PHCS Commercial |
$312.47
|
| Rate for Payer: United Healthcare All Payer |
$286.43
|
|
|
BETADINE 0.35% 1,000ML LAVAGE
|
Facility
|
OP
|
$325.49
|
|
|
Service Code
|
NDC 65041130
|
| Hospital Charge Code |
25003740
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$312.47 |
| Rate for Payer: Humana Commercial |
$276.67
|
| Rate for Payer: Humana KY Medicaid |
$111.94
|
| Rate for Payer: Kentucky WC Medicaid |
$113.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$240.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.43
|
| Rate for Payer: Ohio Health Group HMO |
$244.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.90
|
| Rate for Payer: PHCS Commercial |
$312.47
|
| Rate for Payer: United Healthcare All Payer |
$286.43
|
| Rate for Payer: Aetna Commercial |
$250.63
|
| Rate for Payer: Anthem Medicaid |
$111.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.88
|
| Rate for Payer: Cash Price |
$162.74
|
| Rate for Payer: Cigna Commercial |
$270.16
|
| Rate for Payer: First Health Commercial |
$309.22
|
|
|
BETADINE 5% OPTH 30 ML
|
Facility
|
OP
|
$92.08
|
|
|
Service Code
|
NDC 65041130
|
| Hospital Charge Code |
25002887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Aetna Commercial |
$70.90
|
| Rate for Payer: Anthem Medicaid |
$31.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.82
|
| Rate for Payer: Cash Price |
$46.04
|
| Rate for Payer: Cigna Commercial |
$76.43
|
| Rate for Payer: First Health Commercial |
$87.48
|
| Rate for Payer: Humana Commercial |
$78.27
|
| Rate for Payer: Humana KY Medicaid |
$31.67
|
| Rate for Payer: Kentucky WC Medicaid |
$31.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.03
|
| Rate for Payer: Ohio Health Group HMO |
$69.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.54
|
| Rate for Payer: PHCS Commercial |
$88.40
|
| Rate for Payer: United Healthcare All Payer |
$81.03
|
|
|
BETADINE 5% OPTH 30 ML
|
Facility
|
IP
|
$92.08
|
|
|
Service Code
|
NDC 65041130
|
| Hospital Charge Code |
25002887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Humana Commercial |
$78.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.03
|
| Rate for Payer: Ohio Health Group HMO |
$69.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.54
|
| Rate for Payer: PHCS Commercial |
$88.40
|
| Rate for Payer: United Healthcare All Payer |
$81.03
|
| Rate for Payer: Aetna Commercial |
$70.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.82
|
| Rate for Payer: Cash Price |
$46.04
|
| Rate for Payer: Cigna Commercial |
$76.43
|
| Rate for Payer: First Health Commercial |
$87.48
|
|
|
BETADINE 5% OPTHAL 30ML
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
25002887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
BETADINE 5% OPTHAL 30ML
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
25002887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
BETADINE (POVID IOD) SOLN .5OZ
|
Facility
|
OP
|
$9.44
|
|
|
Service Code
|
NDC 67618015005
|
| Hospital Charge Code |
25002885
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna Commercial |
$7.27
|
| Rate for Payer: Anthem Medicaid |
$3.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.36
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Cigna Commercial |
$7.84
|
| Rate for Payer: First Health Commercial |
$8.97
|
| Rate for Payer: Humana Commercial |
$8.02
|
| Rate for Payer: Humana KY Medicaid |
$3.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.31
|
| Rate for Payer: Ohio Health Group HMO |
$7.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$9.06
|
| Rate for Payer: United Healthcare All Payer |
$8.31
|
|
|
BETADINE (POVID IOD) SOLN .5OZ
|
Facility
|
IP
|
$9.44
|
|
|
Service Code
|
NDC 67618015005
|
| Hospital Charge Code |
25002885
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna Commercial |
$7.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.36
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Cigna Commercial |
$7.84
|
| Rate for Payer: First Health Commercial |
$8.97
|
| Rate for Payer: Humana Commercial |
$8.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.31
|
| Rate for Payer: Ohio Health Group HMO |
$7.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$9.06
|
| Rate for Payer: United Healthcare All Payer |
$8.31
|
|
|
BETADINE (POVIDONE IOD) OI 1OZ
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 536127180
|
| Hospital Charge Code |
25000328
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: First Health Commercial |
$0.06
|
| Rate for Payer: Humana Commercial |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.05
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Payer |
$0.05
|
|
|
BETADINE (POVIDONE IOD) OI 1OZ
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 536127180
|
| Hospital Charge Code |
25000328
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem Medicaid |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.05
|
| Rate for Payer: First Health Commercial |
$0.06
|
| Rate for Payer: Humana Commercial |
$0.05
|
| Rate for Payer: Humana KY Medicaid |
$0.02
|
| Rate for Payer: Kentucky WC Medicaid |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.05
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.06
|
| Rate for Payer: United Healthcare All Payer |
$0.05
|
|
|
BETADINE SWAB 1 EACH
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 67618015301
|
| Hospital Charge Code |
25003859
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
BETADINE SWAB 1 EACH
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 67618015301
|
| Hospital Charge Code |
25003859
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
BETAGAN (LEVOBUNOLOL)0.5% 5ML
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
NDC 24208050505
|
| Hospital Charge Code |
25000329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.73
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna Commercial |
$0.77
|
| Rate for Payer: First Health Commercial |
$0.88
|
| Rate for Payer: Humana Commercial |
$0.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.82
|
| Rate for Payer: Ohio Health Group HMO |
$0.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.29
|
| Rate for Payer: PHCS Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Payer |
$0.82
|
|
|
BETAGAN (LEVOBUNOLOL)0.5% 5ML
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
NDC 24208050505
|
| Hospital Charge Code |
25000329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Anthem Medicaid |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.73
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna Commercial |
$0.77
|
| Rate for Payer: First Health Commercial |
$0.88
|
| Rate for Payer: Humana Commercial |
$0.79
|
| Rate for Payer: Humana KY Medicaid |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$0.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.82
|
| Rate for Payer: Ohio Health Group HMO |
$0.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.29
|
| Rate for Payer: PHCS Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Payer |
$0.82
|
|
|
BETA-HYDROXYBUTYRATE
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
30001828
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.17
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| Rate for Payer: Humana KY Medicaid |
$8.17
|
| Rate for Payer: Humana Medicare Advantage |
$8.17
|
| Rate for Payer: Kentucky WC Medicaid |
$8.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.29
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
BETA-HYDROXYBUTYRATE
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
30001828
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: Aetna Commercial |
$45.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.38
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cigna Commercial |
$48.97
|
| Rate for Payer: First Health Commercial |
$56.05
|
| Rate for Payer: Humana Commercial |
$50.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$48.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$43.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.92
|
| Rate for Payer: Ohio Health Group HMO |
$44.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.29
|
| Rate for Payer: PHCS Commercial |
$56.64
|
| Rate for Payer: United Healthcare All Payer |
$51.92
|
|
|
BETA LACTAMASE
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
30001321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
BETA LACTAMASE
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
30001321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$4.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.75
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$4.75
|
| Rate for Payer: Humana Medicare Advantage |
$4.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
BETAPACE (SOTALOL) 80 MG
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 50268072415
|
| Hospital Charge Code |
25000332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| 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 |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
BETAPACE (SOTALOL) 80 MG
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 50268072415
|
| Hospital Charge Code |
25000332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| 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 |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
