|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Professional
|
Both
|
$19.38
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$11.63 |
| Rate for Payer: Aetna Commercial |
$0.68
|
| Rate for Payer: Ambetter Exchange |
$0.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.58
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Healthspan PPO |
$2.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.48
|
| Rate for Payer: Multiplan PHCS |
$11.63
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.62
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.48
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Facility
|
OP
|
$19.38
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna Commercial |
$14.92
|
| Rate for Payer: Anthem Medicaid |
$6.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.12
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cigna Commercial |
$16.09
|
| Rate for Payer: First Health Commercial |
$18.41
|
| Rate for Payer: Humana Commercial |
$16.47
|
| Rate for Payer: Humana KY Medicaid |
$6.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.05
|
| Rate for Payer: Ohio Health Group HMO |
$14.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.37
|
| Rate for Payer: PHCS Commercial |
$18.60
|
| Rate for Payer: United Healthcare All Payer |
$17.05
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Facility
|
OP
|
$77.52
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$59.69
|
| Rate for Payer: Anthem Medicaid |
$26.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.47
|
| Rate for Payer: Cash Price |
$38.76
|
| Rate for Payer: Cigna Commercial |
$64.34
|
| Rate for Payer: First Health Commercial |
$73.64
|
| Rate for Payer: Humana Commercial |
$65.89
|
| Rate for Payer: Humana KY Medicaid |
$26.66
|
| Rate for Payer: Kentucky WC Medicaid |
$26.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.22
|
| Rate for Payer: Ohio Health Group HMO |
$58.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.49
|
| Rate for Payer: PHCS Commercial |
$74.42
|
| Rate for Payer: United Healthcare All Payer |
$68.22
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$59.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.47
|
| Rate for Payer: Cash Price |
$38.76
|
| Rate for Payer: Cigna Commercial |
$64.34
|
| Rate for Payer: First Health Commercial |
$73.64
|
| Rate for Payer: Humana Commercial |
$65.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.22
|
| Rate for Payer: Ohio Health Group HMO |
$58.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.49
|
| Rate for Payer: PHCS Commercial |
$74.42
|
| Rate for Payer: United Healthcare All Payer |
$68.22
|
|
|
ROCEPHIN 250MG IM(1 GM VIAL)
|
Facility
|
IP
|
$19.38
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636T0021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna Commercial |
$14.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.12
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cigna Commercial |
$16.09
|
| Rate for Payer: First Health Commercial |
$18.41
|
| Rate for Payer: Humana Commercial |
$16.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.05
|
| Rate for Payer: Ohio Health Group HMO |
$14.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.37
|
| Rate for Payer: PHCS Commercial |
$18.60
|
| Rate for Payer: United Healthcare All Payer |
$17.05
|
|
|
ROCEPHIN (CEFTRIAXON 250MG/1ML
|
Facility
|
OP
|
$77.69
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.31 |
| Max. Negotiated Rate |
$74.58 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Anthem Medicaid |
$26.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.60
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cigna Commercial |
$64.48
|
| Rate for Payer: First Health Commercial |
$73.81
|
| Rate for Payer: Humana Commercial |
$66.04
|
| Rate for Payer: Humana KY Medicaid |
$26.72
|
| Rate for Payer: Kentucky WC Medicaid |
$26.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.37
|
| Rate for Payer: Ohio Health Group HMO |
$58.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.61
|
| Rate for Payer: PHCS Commercial |
$74.58
|
| Rate for Payer: United Healthcare All Payer |
$68.37
|
|
|
ROCEPHIN (CEFTRIAXON 250MG/1ML
|
Facility
|
IP
|
$77.69
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.31 |
| Max. Negotiated Rate |
$74.58 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.60
|
| Rate for Payer: Cash Price |
$38.84
|
| Rate for Payer: Cigna Commercial |
$64.48
|
| Rate for Payer: First Health Commercial |
$73.81
|
| Rate for Payer: Humana Commercial |
$66.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.37
|
| Rate for Payer: Ohio Health Group HMO |
$58.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.61
|
| Rate for Payer: PHCS Commercial |
$74.58
|
| Rate for Payer: United Healthcare All Payer |
$68.37
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Professional
|
Both
|
$77.40
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$46.44 |
| Rate for Payer: Aetna Commercial |
$0.68
|
| Rate for Payer: Ambetter Exchange |
$0.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.58
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Healthspan PPO |
$2.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.48
|
| Rate for Payer: Multiplan PHCS |
$46.44
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.62
|
| Rate for Payer: UHCCP Medicaid |
$27.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.48
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Facility
|
OP
|
$77.40
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Anthem Medicaid |
$26.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$64.24
|
| Rate for Payer: First Health Commercial |
$73.53
|
| Rate for Payer: Humana Commercial |
$65.79
|
| Rate for Payer: Humana KY Medicaid |
$26.62
|
| Rate for Payer: Kentucky WC Medicaid |
$26.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.11
|
| Rate for Payer: Ohio Health Group HMO |
$58.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.41
|
| Rate for Payer: PHCS Commercial |
$74.30
|
| Rate for Payer: United Healthcare All Payer |
$68.11
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Facility
|
OP
|
$77.40
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Anthem Medicaid |
$26.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$64.24
|
| Rate for Payer: First Health Commercial |
$73.53
|
| Rate for Payer: Humana Commercial |
$65.79
|
| Rate for Payer: Humana KY Medicaid |
$26.62
|
| Rate for Payer: Kentucky WC Medicaid |
$26.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.11
|
| Rate for Payer: Ohio Health Group HMO |
$58.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.41
|
| Rate for Payer: PHCS Commercial |
$74.30
|
| Rate for Payer: United Healthcare All Payer |
$68.11
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Facility
|
IP
|
$77.40
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$64.24
|
| Rate for Payer: First Health Commercial |
$73.53
|
| Rate for Payer: Humana Commercial |
$65.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.11
|
| Rate for Payer: Ohio Health Group HMO |
$58.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.41
|
| Rate for Payer: PHCS Commercial |
$74.30
|
| Rate for Payer: United Healthcare All Payer |
$68.11
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Facility
|
IP
|
$77.40
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$64.24
|
| Rate for Payer: First Health Commercial |
$73.53
|
| Rate for Payer: Humana Commercial |
$65.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.11
|
| Rate for Payer: Ohio Health Group HMO |
$58.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.41
|
| Rate for Payer: PHCS Commercial |
$74.30
|
| Rate for Payer: United Healthcare All Payer |
$68.11
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Facility
|
IP
|
$77.40
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636T0022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$64.24
|
| Rate for Payer: First Health Commercial |
$73.53
|
| Rate for Payer: Humana Commercial |
$65.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.11
|
| Rate for Payer: Ohio Health Group HMO |
$58.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.41
|
| Rate for Payer: PHCS Commercial |
$74.30
|
| Rate for Payer: United Healthcare All Payer |
$68.11
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Facility
|
OP
|
$77.40
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636T0022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Anthem Medicaid |
$26.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$64.24
|
| Rate for Payer: First Health Commercial |
$73.53
|
| Rate for Payer: Humana Commercial |
$65.79
|
| Rate for Payer: Humana KY Medicaid |
$26.62
|
| Rate for Payer: Kentucky WC Medicaid |
$26.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.11
|
| Rate for Payer: Ohio Health Group HMO |
$58.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.41
|
| Rate for Payer: PHCS Commercial |
$74.30
|
| Rate for Payer: United Healthcare All Payer |
$68.11
|
|
|
ROCEPHIN(PEDIATRIC IV)1GM/10ML
|
Facility
|
OP
|
$77.52
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25003808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$59.69
|
| Rate for Payer: Anthem Medicaid |
$26.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.47
|
| Rate for Payer: Cash Price |
$38.76
|
| Rate for Payer: Cigna Commercial |
$64.34
|
| Rate for Payer: First Health Commercial |
$73.64
|
| Rate for Payer: Humana Commercial |
$65.89
|
| Rate for Payer: Humana KY Medicaid |
$26.66
|
| Rate for Payer: Kentucky WC Medicaid |
$26.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.22
|
| Rate for Payer: Ohio Health Group HMO |
$58.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.49
|
| Rate for Payer: PHCS Commercial |
$74.42
|
| Rate for Payer: United Healthcare All Payer |
$68.22
|
|
|
ROCEPHIN(PEDIATRIC IV)1GM/10ML
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25003808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$59.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.47
|
| Rate for Payer: Cash Price |
$38.76
|
| Rate for Payer: Cigna Commercial |
$64.34
|
| Rate for Payer: First Health Commercial |
$73.64
|
| Rate for Payer: Humana Commercial |
$65.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.22
|
| Rate for Payer: Ohio Health Group HMO |
$58.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.49
|
| Rate for Payer: PHCS Commercial |
$74.42
|
| Rate for Payer: United Healthcare All Payer |
$68.22
|
|
|
ROD BALL TIP GUIDE 3.0*1000MM
|
Facility
|
OP
|
$2,067.98
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.39 |
| Max. Negotiated Rate |
$1,985.26 |
| Rate for Payer: Aetna Commercial |
$1,592.34
|
| Rate for Payer: Anthem Medicaid |
$711.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,613.02
|
| Rate for Payer: Cash Price |
$1,033.99
|
| Rate for Payer: Cigna Commercial |
$1,716.42
|
| Rate for Payer: First Health Commercial |
$1,964.58
|
| Rate for Payer: Humana Commercial |
$1,757.78
|
| Rate for Payer: Humana KY Medicaid |
$711.18
|
| Rate for Payer: Kentucky WC Medicaid |
$718.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,695.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,526.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$725.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,819.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,550.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.91
|
| Rate for Payer: PHCS Commercial |
$1,985.26
|
| Rate for Payer: United Healthcare All Payer |
$1,819.82
|
|
|
ROD BALL TIP GUIDE 3.0*1000MM
|
Facility
|
IP
|
$2,067.98
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.39 |
| Max. Negotiated Rate |
$1,985.26 |
| Rate for Payer: Aetna Commercial |
$1,592.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,613.02
|
| Rate for Payer: Cash Price |
$1,033.99
|
| Rate for Payer: Cigna Commercial |
$1,716.42
|
| Rate for Payer: First Health Commercial |
$1,964.58
|
| Rate for Payer: Humana Commercial |
$1,757.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,695.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,526.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,819.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,550.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.91
|
| Rate for Payer: PHCS Commercial |
$1,985.26
|
| Rate for Payer: United Healthcare All Payer |
$1,819.82
|
|
|
ROD FIBULA 3.0*110MM
|
Facility
|
IP
|
$7,241.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.39 |
| Max. Negotiated Rate |
$6,951.65 |
| Rate for Payer: Aetna Commercial |
$5,575.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,648.21
|
| Rate for Payer: Cash Price |
$3,620.65
|
| Rate for Payer: Cigna Commercial |
$6,010.28
|
| Rate for Payer: First Health Commercial |
$6,879.23
|
| Rate for Payer: Humana Commercial |
$6,155.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,937.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,344.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,372.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,430.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,793.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,299.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,996.50
|
| Rate for Payer: PHCS Commercial |
$6,951.65
|
| Rate for Payer: United Healthcare All Payer |
$6,372.34
|
|
|
ROD FIBULA 3.0*110MM
|
Facility
|
OP
|
$7,241.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.39 |
| Max. Negotiated Rate |
$6,951.65 |
| Rate for Payer: Aetna Commercial |
$5,575.80
|
| Rate for Payer: Anthem Medicaid |
$2,490.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,648.21
|
| Rate for Payer: Cash Price |
$3,620.65
|
| Rate for Payer: Cigna Commercial |
$6,010.28
|
| Rate for Payer: First Health Commercial |
$6,879.23
|
| Rate for Payer: Humana Commercial |
$6,155.10
|
| Rate for Payer: Humana KY Medicaid |
$2,490.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,937.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,344.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,540.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,372.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,430.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,793.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,299.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,996.50
|
| Rate for Payer: PHCS Commercial |
$6,951.65
|
| Rate for Payer: United Healthcare All Payer |
$6,372.34
|
|
|
ROD FIBULA 3.0*145MM
|
Facility
|
OP
|
$7,241.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.39 |
| Max. Negotiated Rate |
$6,951.65 |
| Rate for Payer: Aetna Commercial |
$5,575.80
|
| Rate for Payer: Anthem Medicaid |
$2,490.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,648.21
|
| Rate for Payer: Cash Price |
$3,620.65
|
| Rate for Payer: Cigna Commercial |
$6,010.28
|
| Rate for Payer: First Health Commercial |
$6,879.23
|
| Rate for Payer: Humana Commercial |
$6,155.10
|
| Rate for Payer: Humana KY Medicaid |
$2,490.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,937.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,344.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,540.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,372.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,430.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,793.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,299.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,996.50
|
| Rate for Payer: PHCS Commercial |
$6,951.65
|
| Rate for Payer: United Healthcare All Payer |
$6,372.34
|
|
|
ROD FIBULA 3.0*145MM
|
Facility
|
IP
|
$7,241.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.39 |
| Max. Negotiated Rate |
$6,951.65 |
| Rate for Payer: Aetna Commercial |
$5,575.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,648.21
|
| Rate for Payer: Cash Price |
$3,620.65
|
| Rate for Payer: Cigna Commercial |
$6,010.28
|
| Rate for Payer: First Health Commercial |
$6,879.23
|
| Rate for Payer: Humana Commercial |
$6,155.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,937.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,344.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,372.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,430.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,793.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,299.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,996.50
|
| Rate for Payer: PHCS Commercial |
$6,951.65
|
| Rate for Payer: United Healthcare All Payer |
$6,372.34
|
|
|
ROD FIBULA 3.0*180MM
|
Facility
|
IP
|
$6,869.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.70 |
| Max. Negotiated Rate |
$6,594.24 |
| Rate for Payer: Aetna Commercial |
$5,289.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,357.82
|
| Rate for Payer: Cash Price |
$3,434.50
|
| Rate for Payer: Cigna Commercial |
$5,701.27
|
| Rate for Payer: First Health Commercial |
$6,525.55
|
| Rate for Payer: Humana Commercial |
$5,838.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,632.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,069.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,060.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,044.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,151.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,976.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,739.61
|
| Rate for Payer: PHCS Commercial |
$6,594.24
|
| Rate for Payer: United Healthcare All Payer |
$6,044.72
|
|
|
ROD FIBULA 3.0*180MM
|
Facility
|
OP
|
$6,869.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.70 |
| Max. Negotiated Rate |
$6,594.24 |
| Rate for Payer: Aetna Commercial |
$5,289.13
|
| Rate for Payer: Anthem Medicaid |
$2,362.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,357.82
|
| Rate for Payer: Cash Price |
$3,434.50
|
| Rate for Payer: Cigna Commercial |
$5,701.27
|
| Rate for Payer: First Health Commercial |
$6,525.55
|
| Rate for Payer: Humana Commercial |
$5,838.65
|
| Rate for Payer: Humana KY Medicaid |
$2,362.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,386.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,632.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,069.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,060.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,409.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,044.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,151.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,495.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,976.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,739.61
|
| Rate for Payer: PHCS Commercial |
$6,594.24
|
| Rate for Payer: United Healthcare All Payer |
$6,044.72
|
|
|
ROD FIBULA 3.6*110MM
|
Facility
|
OP
|
$7,241.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.39 |
| Max. Negotiated Rate |
$6,951.65 |
| Rate for Payer: Aetna Commercial |
$5,575.80
|
| Rate for Payer: Anthem Medicaid |
$2,490.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,648.21
|
| Rate for Payer: Cash Price |
$3,620.65
|
| Rate for Payer: Cigna Commercial |
$6,010.28
|
| Rate for Payer: First Health Commercial |
$6,879.23
|
| Rate for Payer: Humana Commercial |
$6,155.10
|
| Rate for Payer: Humana KY Medicaid |
$2,490.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,937.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,344.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,540.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,372.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,430.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,793.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,299.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,996.50
|
| Rate for Payer: PHCS Commercial |
$6,951.65
|
| Rate for Payer: United Healthcare All Payer |
$6,372.34
|
|
