|
BIAXIN (CLARITHROMY 500MG/1TAB
|
Facility
|
IP
|
$10.24
|
|
|
Service Code
|
NDC 50268017913
|
| Hospital Charge Code |
25002893
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.99
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.73
|
| Rate for Payer: Humana Commercial |
$8.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.01
|
| Rate for Payer: Ohio Health Group HMO |
$7.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$9.83
|
| Rate for Payer: United Healthcare All Payer |
$9.01
|
|
|
BIAXIN (CLARITHROMY 500MG/1TAB
|
Facility
|
OP
|
$10.24
|
|
|
Service Code
|
NDC 50268017913
|
| Hospital Charge Code |
25002893
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: Anthem Medicaid |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.99
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.73
|
| Rate for Payer: Humana Commercial |
$8.70
|
| Rate for Payer: Humana KY Medicaid |
$3.52
|
| Rate for Payer: Kentucky WC Medicaid |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.01
|
| Rate for Payer: Ohio Health Group HMO |
$7.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$9.83
|
| Rate for Payer: United Healthcare All Payer |
$9.01
|
|
|
BI BR IMPLANT REM-INTACT OFC
|
Professional
|
Both
|
$2,000.00
|
|
| Hospital Charge Code |
22200718
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
|
|
BI BR IMPLANT REM-RUPT OFC
|
Professional
|
Both
|
$2,000.00
|
|
| Hospital Charge Code |
22200719
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Facility
|
OP
|
$46.91
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$45.03 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Anthem Medicaid |
$16.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.73
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cigna Commercial |
$38.94
|
| Rate for Payer: First Health Commercial |
$44.56
|
| Rate for Payer: Humana Commercial |
$39.87
|
| Rate for Payer: Humana KY Medicaid |
$16.13
|
| Rate for Payer: Humana Medicare Advantage |
$17.58
|
| Rate for Payer: Kentucky WC Medicaid |
$16.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.28
|
| Rate for Payer: Ohio Health Group HMO |
$35.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.54
|
| Rate for Payer: PHCS Commercial |
$45.03
|
| Rate for Payer: United Healthcare All Payer |
$41.28
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Facility
|
OP
|
$46.91
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
636T0012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$45.03 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Anthem Medicaid |
$16.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.73
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cigna Commercial |
$38.94
|
| Rate for Payer: First Health Commercial |
$44.56
|
| Rate for Payer: Humana Commercial |
$39.87
|
| Rate for Payer: Humana KY Medicaid |
$16.13
|
| Rate for Payer: Humana Medicare Advantage |
$17.58
|
| Rate for Payer: Kentucky WC Medicaid |
$16.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.28
|
| Rate for Payer: Ohio Health Group HMO |
$35.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.54
|
| Rate for Payer: PHCS Commercial |
$45.03
|
| Rate for Payer: United Healthcare All Payer |
$41.28
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Facility
|
IP
|
$46.91
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$45.03 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.59
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cigna Commercial |
$38.94
|
| Rate for Payer: First Health Commercial |
$44.56
|
| Rate for Payer: Humana Commercial |
$39.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.28
|
| Rate for Payer: Ohio Health Group HMO |
$35.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.54
|
| Rate for Payer: PHCS Commercial |
$45.03
|
| Rate for Payer: United Healthcare All Payer |
$41.28
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Facility
|
IP
|
$628.92
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
25001890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$603.76 |
| Rate for Payer: Aetna Commercial |
$484.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$490.56
|
| Rate for Payer: Cash Price |
$314.46
|
| Rate for Payer: Cigna Commercial |
$522.00
|
| Rate for Payer: First Health Commercial |
$597.47
|
| Rate for Payer: Humana Commercial |
$534.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$515.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$553.45
|
| Rate for Payer: Ohio Health Group HMO |
$471.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.97
|
| Rate for Payer: PHCS Commercial |
$603.76
|
| Rate for Payer: United Healthcare All Payer |
$553.45
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Facility
|
IP
|
$46.91
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
636T0012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$45.03 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.59
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cigna Commercial |
$38.94
|
| Rate for Payer: First Health Commercial |
$44.56
|
| Rate for Payer: Humana Commercial |
$39.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.28
|
| Rate for Payer: Ohio Health Group HMO |
$35.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.54
|
| Rate for Payer: PHCS Commercial |
$45.03
|
| Rate for Payer: United Healthcare All Payer |
$41.28
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Facility
|
OP
|
$628.92
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
25001890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$603.76 |
| Rate for Payer: Aetna Commercial |
$484.27
|
| Rate for Payer: Anthem Medicaid |
$216.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$490.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.73
|
| Rate for Payer: Cash Price |
$314.46
|
| Rate for Payer: Cash Price |
$314.46
|
| Rate for Payer: Cigna Commercial |
$522.00
|
| Rate for Payer: First Health Commercial |
$597.47
|
| Rate for Payer: Humana Commercial |
$534.58
|
| Rate for Payer: Humana KY Medicaid |
$216.29
|
| Rate for Payer: Humana Medicare Advantage |
$17.58
|
| Rate for Payer: Kentucky WC Medicaid |
$218.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$515.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$220.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$553.45
|
| Rate for Payer: Ohio Health Group HMO |
$471.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.97
|
| Rate for Payer: PHCS Commercial |
$603.76
|
| Rate for Payer: United Healthcare All Payer |
$553.45
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Professional
|
Both
|
$46.91
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$46.91 |
| Rate for Payer: Aetna Commercial |
$16.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.91
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.10
|
| Rate for Payer: Multiplan PHCS |
$28.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.84
|
| Rate for Payer: UHCCP Medicaid |
$16.42
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Facility
|
OP
|
$610.66
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
25003926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$586.23 |
| Rate for Payer: Aetna Commercial |
$470.21
|
| Rate for Payer: Anthem Medicaid |
$210.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.73
|
| Rate for Payer: Cash Price |
$305.33
|
| Rate for Payer: Cash Price |
$305.33
|
| Rate for Payer: Cigna Commercial |
$506.85
|
| Rate for Payer: First Health Commercial |
$580.13
|
| Rate for Payer: Humana Commercial |
$519.06
|
| Rate for Payer: Humana KY Medicaid |
$210.01
|
| Rate for Payer: Humana Medicare Advantage |
$17.58
|
| Rate for Payer: Kentucky WC Medicaid |
$212.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$500.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$214.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$537.38
|
| Rate for Payer: Ohio Health Group HMO |
$458.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.30
|
| Rate for Payer: PHCS Commercial |
$586.23
|
| Rate for Payer: United Healthcare All Payer |
$537.38
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Facility
|
OP
|
$46.91
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$45.03 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Anthem Medicaid |
$16.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.73
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cigna Commercial |
$38.94
|
| Rate for Payer: First Health Commercial |
$44.56
|
| Rate for Payer: Humana Commercial |
$39.87
|
| Rate for Payer: Humana KY Medicaid |
$16.13
|
| Rate for Payer: Humana Medicare Advantage |
$17.58
|
| Rate for Payer: Kentucky WC Medicaid |
$16.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.28
|
| Rate for Payer: Ohio Health Group HMO |
$35.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.54
|
| Rate for Payer: PHCS Commercial |
$45.03
|
| Rate for Payer: United Healthcare All Payer |
$41.28
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Professional
|
Both
|
$46.91
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$46.91 |
| Rate for Payer: Aetna Commercial |
$16.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.91
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.10
|
| Rate for Payer: Multiplan PHCS |
$28.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.84
|
| Rate for Payer: UHCCP Medicaid |
$16.42
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Facility
|
IP
|
$610.66
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
25003926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.39 |
| Max. Negotiated Rate |
$586.23 |
| Rate for Payer: Aetna Commercial |
$470.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.31
|
| Rate for Payer: Cash Price |
$305.33
|
| Rate for Payer: Cigna Commercial |
$506.85
|
| Rate for Payer: First Health Commercial |
$580.13
|
| Rate for Payer: Humana Commercial |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$500.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$537.38
|
| Rate for Payer: Ohio Health Group HMO |
$458.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.30
|
| Rate for Payer: PHCS Commercial |
$586.23
|
| Rate for Payer: United Healthcare All Payer |
$537.38
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Facility
|
IP
|
$46.91
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$45.03 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.59
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cigna Commercial |
$38.94
|
| Rate for Payer: First Health Commercial |
$44.56
|
| Rate for Payer: Humana Commercial |
$39.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.28
|
| Rate for Payer: Ohio Health Group HMO |
$35.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.54
|
| Rate for Payer: PHCS Commercial |
$45.03
|
| Rate for Payer: United Healthcare All Payer |
$41.28
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Facility
|
OP
|
$46.91
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
636T0113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$45.03 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Anthem Medicaid |
$16.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.73
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cigna Commercial |
$38.94
|
| Rate for Payer: First Health Commercial |
$44.56
|
| Rate for Payer: Humana Commercial |
$39.87
|
| Rate for Payer: Humana KY Medicaid |
$16.13
|
| Rate for Payer: Humana Medicare Advantage |
$17.58
|
| Rate for Payer: Kentucky WC Medicaid |
$16.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.28
|
| Rate for Payer: Ohio Health Group HMO |
$35.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.54
|
| Rate for Payer: PHCS Commercial |
$45.03
|
| Rate for Payer: United Healthcare All Payer |
$41.28
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Facility
|
IP
|
$46.91
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
636T0113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$45.03 |
| Rate for Payer: Aetna Commercial |
$36.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.59
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cigna Commercial |
$38.94
|
| Rate for Payer: First Health Commercial |
$44.56
|
| Rate for Payer: Humana Commercial |
$39.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.28
|
| Rate for Payer: Ohio Health Group HMO |
$35.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.54
|
| Rate for Payer: PHCS Commercial |
$45.03
|
| Rate for Payer: United Healthcare All Payer |
$41.28
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Facility
|
IP
|
$86.89
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
636T0014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$83.41 |
| Rate for Payer: Aetna Commercial |
$66.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.77
|
| Rate for Payer: Cash Price |
$43.44
|
| Rate for Payer: Cigna Commercial |
$72.12
|
| Rate for Payer: First Health Commercial |
$82.55
|
| Rate for Payer: Humana Commercial |
$73.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.46
|
| Rate for Payer: Ohio Health Group HMO |
$65.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.94
|
| Rate for Payer: PHCS Commercial |
$83.41
|
| Rate for Payer: United Healthcare All Payer |
$76.46
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Facility
|
OP
|
$86.89
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$83.41 |
| Rate for Payer: Aetna Commercial |
$66.91
|
| Rate for Payer: Anthem Medicaid |
$29.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.34
|
| Rate for Payer: Cash Price |
$43.44
|
| Rate for Payer: Cash Price |
$43.44
|
| Rate for Payer: Cigna Commercial |
$72.12
|
| Rate for Payer: First Health Commercial |
$82.55
|
| Rate for Payer: Humana Commercial |
$73.86
|
| Rate for Payer: Humana KY Medicaid |
$29.88
|
| Rate for Payer: Humana Medicare Advantage |
$21.73
|
| Rate for Payer: Kentucky WC Medicaid |
$30.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.46
|
| Rate for Payer: Ohio Health Group HMO |
$65.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.94
|
| Rate for Payer: PHCS Commercial |
$83.41
|
| Rate for Payer: United Healthcare All Payer |
$76.46
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Facility
|
IP
|
$86.89
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$83.41 |
| Rate for Payer: Aetna Commercial |
$66.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.77
|
| Rate for Payer: Cash Price |
$43.44
|
| Rate for Payer: Cigna Commercial |
$72.12
|
| Rate for Payer: First Health Commercial |
$82.55
|
| Rate for Payer: Humana Commercial |
$73.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.46
|
| Rate for Payer: Ohio Health Group HMO |
$65.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.94
|
| Rate for Payer: PHCS Commercial |
$83.41
|
| Rate for Payer: United Healthcare All Payer |
$76.46
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Facility
|
OP
|
$560.30
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
25001892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$537.89 |
| Rate for Payer: Aetna Commercial |
$431.43
|
| Rate for Payer: Anthem Medicaid |
$192.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.34
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cigna Commercial |
$465.05
|
| Rate for Payer: First Health Commercial |
$532.28
|
| Rate for Payer: Humana Commercial |
$476.26
|
| Rate for Payer: Humana KY Medicaid |
$192.69
|
| Rate for Payer: Humana Medicare Advantage |
$21.73
|
| Rate for Payer: Kentucky WC Medicaid |
$194.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.06
|
| Rate for Payer: Ohio Health Group HMO |
$420.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.69
|
| Rate for Payer: PHCS Commercial |
$537.89
|
| Rate for Payer: United Healthcare All Payer |
$493.06
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Facility
|
OP
|
$86.89
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
636T0014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$83.41 |
| Rate for Payer: Aetna Commercial |
$66.91
|
| Rate for Payer: Anthem Medicaid |
$29.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.34
|
| Rate for Payer: Cash Price |
$43.44
|
| Rate for Payer: Cash Price |
$43.44
|
| Rate for Payer: Cigna Commercial |
$72.12
|
| Rate for Payer: First Health Commercial |
$82.55
|
| Rate for Payer: Humana Commercial |
$73.86
|
| Rate for Payer: Humana KY Medicaid |
$29.88
|
| Rate for Payer: Humana Medicare Advantage |
$21.73
|
| Rate for Payer: Kentucky WC Medicaid |
$30.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.46
|
| Rate for Payer: Ohio Health Group HMO |
$65.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.94
|
| Rate for Payer: PHCS Commercial |
$83.41
|
| Rate for Payer: United Healthcare All Payer |
$76.46
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Facility
|
IP
|
$560.30
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
25001892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.84 |
| Max. Negotiated Rate |
$537.89 |
| Rate for Payer: Aetna Commercial |
$431.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.03
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cigna Commercial |
$465.05
|
| Rate for Payer: First Health Commercial |
$532.28
|
| Rate for Payer: Humana Commercial |
$476.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.06
|
| Rate for Payer: Ohio Health Group HMO |
$420.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.69
|
| Rate for Payer: PHCS Commercial |
$537.89
|
| Rate for Payer: United Healthcare All Payer |
$493.06
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Professional
|
Both
|
$86.89
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$86.89 |
| Rate for Payer: Aetna Commercial |
$20.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.89
|
| Rate for Payer: Cash Price |
$43.44
|
| Rate for Payer: Cash Price |
$43.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.60
|
| Rate for Payer: Multiplan PHCS |
$52.13
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.82
|
| Rate for Payer: UHCCP Medicaid |
$30.41
|
|
