|
ASSMT & CARE PLN PT COG IMP (T
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 99483
|
| Hospital Charge Code |
510T0373
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.60
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
ASSMT & CARE PLN PT COG IMP (T
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 99483
|
| Hospital Charge Code |
510T0373
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem Medicaid |
$220.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$119.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.38
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Humana KY Medicaid |
$220.10
|
| Rate for Payer: Humana Medicare Advantage |
$85.47
|
| Rate for Payer: Kentucky WC Medicaid |
$222.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.60
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
ASTELIN NASAL SPRAY 137MCG
|
Facility
|
IP
|
$0.48
|
|
|
Service Code
|
NDC 60505083305
|
| Hospital Charge Code |
25000270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna Commercial |
$0.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.37
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna Commercial |
$0.40
|
| Rate for Payer: First Health Commercial |
$0.46
|
| Rate for Payer: Humana Commercial |
$0.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.42
|
| Rate for Payer: Ohio Health Group HMO |
$0.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.33
|
| Rate for Payer: PHCS Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Payer |
$0.42
|
|
|
ASTELIN NASAL SPRAY 137MCG
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
NDC 60505083305
|
| Hospital Charge Code |
25000270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna Commercial |
$0.37
|
| Rate for Payer: Anthem Medicaid |
$0.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.37
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna Commercial |
$0.40
|
| Rate for Payer: First Health Commercial |
$0.46
|
| Rate for Payer: Humana Commercial |
$0.41
|
| Rate for Payer: Humana KY Medicaid |
$0.17
|
| Rate for Payer: Kentucky WC Medicaid |
$0.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.42
|
| Rate for Payer: Ohio Health Group HMO |
$0.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.33
|
| Rate for Payer: PHCS Commercial |
$0.46
|
| Rate for Payer: United Healthcare All Payer |
$0.42
|
|
|
AS TIBIA OFFSET STEM 015*92MM
|
Facility
|
IP
|
$17,079.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,123.97 |
| Max. Negotiated Rate |
$16,396.70 |
| Rate for Payer: Aetna Commercial |
$13,151.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,322.32
|
| Rate for Payer: Cash Price |
$8,539.95
|
| Rate for Payer: Cigna Commercial |
$14,176.32
|
| Rate for Payer: First Health Commercial |
$16,225.91
|
| Rate for Payer: Humana Commercial |
$14,517.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,005.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,604.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,123.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,030.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,809.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,663.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,859.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,785.13
|
| Rate for Payer: PHCS Commercial |
$16,396.70
|
| Rate for Payer: United Healthcare All Payer |
$15,030.31
|
|
|
AS TIBIA OFFSET STEM 015*92MM
|
Facility
|
OP
|
$17,079.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,123.97 |
| Max. Negotiated Rate |
$16,396.70 |
| Rate for Payer: Aetna Commercial |
$13,151.52
|
| Rate for Payer: Anthem Medicaid |
$5,873.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,322.32
|
| Rate for Payer: Cash Price |
$8,539.95
|
| Rate for Payer: Cigna Commercial |
$14,176.32
|
| Rate for Payer: First Health Commercial |
$16,225.91
|
| Rate for Payer: Humana Commercial |
$14,517.92
|
| Rate for Payer: Humana KY Medicaid |
$5,873.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5,933.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,005.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,604.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,123.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,991.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,030.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,809.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,663.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,859.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,785.13
|
| Rate for Payer: PHCS Commercial |
$16,396.70
|
| Rate for Payer: United Healthcare All Payer |
$15,030.31
|
|
|
AS TIBIA OFFSET STEM 016*92MM
|
Facility
|
OP
|
$18,256.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.95 |
| Max. Negotiated Rate |
$17,526.24 |
| Rate for Payer: Aetna Commercial |
$14,057.50
|
| Rate for Payer: Anthem Medicaid |
$6,278.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,240.07
|
| Rate for Payer: Cash Price |
$9,128.25
|
| Rate for Payer: Cigna Commercial |
$15,152.90
|
| Rate for Payer: First Health Commercial |
$17,343.67
|
| Rate for Payer: Humana Commercial |
$15,518.02
|
| Rate for Payer: Humana KY Medicaid |
$6,278.41
|
| Rate for Payer: Kentucky WC Medicaid |
$6,342.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,970.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,404.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,065.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,692.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,605.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,883.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,596.99
|
| Rate for Payer: PHCS Commercial |
$17,526.24
|
| Rate for Payer: United Healthcare All Payer |
$16,065.72
|
|
|
AS TIBIA OFFSET STEM 016*92MM
|
Facility
|
IP
|
$18,256.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.95 |
| Max. Negotiated Rate |
$17,526.24 |
| Rate for Payer: Aetna Commercial |
$14,057.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,240.07
|
| Rate for Payer: Cash Price |
$9,128.25
|
| Rate for Payer: Cigna Commercial |
$15,152.90
|
| Rate for Payer: First Health Commercial |
$17,343.67
|
| Rate for Payer: Humana Commercial |
$15,518.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,970.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,065.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,692.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,605.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,883.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,596.99
|
| Rate for Payer: PHCS Commercial |
$17,526.24
|
| Rate for Payer: United Healthcare All Payer |
$16,065.72
|
|
|
ATACAN(CANDESARTCILEXETIL)4MGT
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
NDC 49884065809
|
| Hospital Charge Code |
25000272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Anthem Medicaid |
$3.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.07
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cigna Commercial |
$8.59
|
| Rate for Payer: First Health Commercial |
$9.83
|
| Rate for Payer: Humana Commercial |
$8.80
|
| Rate for Payer: Humana KY Medicaid |
$3.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.11
|
| Rate for Payer: Ohio Health Group HMO |
$7.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.14
|
| Rate for Payer: PHCS Commercial |
$9.94
|
| Rate for Payer: United Healthcare All Payer |
$9.11
|
|
|
ATACAN(CANDESARTCILEXETIL)4MGT
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
NDC 49884065809
|
| Hospital Charge Code |
25000272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.07
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cigna Commercial |
$8.59
|
| Rate for Payer: First Health Commercial |
$9.83
|
| Rate for Payer: Humana Commercial |
$8.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.11
|
| Rate for Payer: Ohio Health Group HMO |
$7.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.14
|
| Rate for Payer: PHCS Commercial |
$9.94
|
| Rate for Payer: United Healthcare All Payer |
$9.11
|
|
|
ATACAND (CANDESARTAN) 16MG TAB
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
NDC 49884066009
|
| Hospital Charge Code |
25000273
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Anthem Medicaid |
$3.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.07
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cigna Commercial |
$8.59
|
| Rate for Payer: First Health Commercial |
$9.83
|
| Rate for Payer: Humana Commercial |
$8.80
|
| Rate for Payer: Humana KY Medicaid |
$3.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.11
|
| Rate for Payer: Ohio Health Group HMO |
$7.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.14
|
| Rate for Payer: PHCS Commercial |
$9.94
|
| Rate for Payer: United Healthcare All Payer |
$9.11
|
|
|
ATACAND (CANDESARTAN) 16MG TAB
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
NDC 49884066009
|
| Hospital Charge Code |
25000273
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$9.94 |
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.07
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cigna Commercial |
$8.59
|
| Rate for Payer: First Health Commercial |
$9.83
|
| Rate for Payer: Humana Commercial |
$8.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.11
|
| Rate for Payer: Ohio Health Group HMO |
$7.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.14
|
| Rate for Payer: PHCS Commercial |
$9.94
|
| Rate for Payer: United Healthcare All Payer |
$9.11
|
|
|
ATARAX (HYDROXYZINE 10MG/1TAB
|
Facility
|
OP
|
$4.47
|
|
|
Service Code
|
NDC 60687066401
|
| Hospital Charge Code |
25000274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
ATARAX (HYDROXYZINE 10MG/1TAB
|
Facility
|
IP
|
$4.47
|
|
|
Service Code
|
NDC 60687066401
|
| Hospital Charge Code |
25000274
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.71
|
| Rate for Payer: First Health Commercial |
$4.25
|
| Rate for Payer: Humana Commercial |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.93
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.29
|
| Rate for Payer: United Healthcare All Payer |
$3.93
|
|
|
ATARAX (HYDROXYZINE) 10MG/5ML
|
Facility
|
IP
|
$5.06
|
|
|
Service Code
|
NDC 54838050280
|
| Hospital Charge Code |
25000276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.95
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cigna Commercial |
$4.20
|
| Rate for Payer: First Health Commercial |
$4.81
|
| Rate for Payer: Humana Commercial |
$4.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.45
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.49
|
| Rate for Payer: PHCS Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Payer |
$4.45
|
|
|
ATARAX (HYDROXYZINE) 10MG/5ML
|
Facility
|
OP
|
$5.06
|
|
|
Service Code
|
NDC 54838050280
|
| Hospital Charge Code |
25000276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$4.86 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Anthem Medicaid |
$1.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.95
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cigna Commercial |
$4.20
|
| Rate for Payer: First Health Commercial |
$4.81
|
| Rate for Payer: Humana Commercial |
$4.30
|
| Rate for Payer: Humana KY Medicaid |
$1.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.45
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.49
|
| Rate for Payer: PHCS Commercial |
$4.86
|
| Rate for Payer: United Healthcare All Payer |
$4.45
|
|
|
ATARAX (HYDROXYZINE 25MG/1TAB
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 60687067501
|
| Hospital Charge Code |
25000275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
ATARAX (HYDROXYZINE 25MG/1TAB
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 60687067501
|
| Hospital Charge Code |
25000275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
A-TEAM
|
Professional
|
Both
|
$105.00
|
|
| Hospital Charge Code |
22200122
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Multiplan PHCS |
$63.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$73.50
|
| Rate for Payer: UHCCP Medicaid |
$36.75
|
|
|
A-TEAM
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
22200122
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem Medicaid |
$36.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.90
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Humana KY Medicaid |
$36.11
|
| Rate for Payer: Kentucky WC Medicaid |
$36.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
A-TEAM
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
22200122
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.90
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
ATHROTOMY METATARSOPHALANGEAL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
76102641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.53 |
| Max. Negotiated Rate |
$843.03 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Ambetter Exchange |
$121.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$84.53
|
| Rate for Payer: Anthem Medicaid |
$125.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$121.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$121.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.79
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$194.78
|
| Rate for Payer: Healthspan PPO |
$843.03
|
| Rate for Payer: Humana Medicaid |
$125.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$141.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$121.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.30
|
| Rate for Payer: Molina Healthcare Passport |
$125.78
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.94
|
| Rate for Payer: UHCCP Medicaid |
$88.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$121.49
|
|
|
ATHROTOMY METATARSOPHALANGEAL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 28022
|
| Hospital Charge Code |
761P2641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.29 |
| Max. Negotiated Rate |
$674.32 |
| Rate for Payer: Aetna Commercial |
$499.66
|
| Rate for Payer: Ambetter Exchange |
$310.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.29
|
| Rate for Payer: Anthem Medicaid |
$210.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$310.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$373.04
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$674.32
|
| Rate for Payer: Healthspan PPO |
$594.14
|
| Rate for Payer: Humana Medicaid |
$210.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$399.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$310.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$214.64
|
| Rate for Payer: Molina Healthcare Passport |
$210.43
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$404.13
|
| Rate for Payer: UHCCP Medicaid |
$174.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$212.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$310.87
|
|
|
ATHROTOMY METATARSOPHALANGEAL
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 28022
|
| Hospital Charge Code |
76102641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.30 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$338.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
ATHROTOMY METATARSOPHALANGEAL
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 28022
|
| Hospital Charge Code |
76102641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
