|
ATRACURIUM 50MG/5ML VIAL (5ML)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
NDC 71288070106
|
| Hospital Charge Code |
25002854
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
ATRACURIUM 50MG/5ML VIAL (5ML)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
NDC 71288070106
|
| Hospital Charge Code |
25002854
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$39.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$39.55
|
| Rate for Payer: Kentucky WC Medicaid |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
ATRICULEZE M HEAD 36MM +12
|
Facility
|
IP
|
$6,788.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,036.61 |
| Max. Negotiated Rate |
$6,517.15 |
| Rate for Payer: Aetna Commercial |
$5,227.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.19
|
| Rate for Payer: Cash Price |
$3,394.35
|
| Rate for Payer: Cigna Commercial |
$5,634.62
|
| Rate for Payer: First Health Commercial |
$6,449.27
|
| Rate for Payer: Humana Commercial |
$5,770.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,566.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,091.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,430.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,906.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,684.20
|
| Rate for Payer: PHCS Commercial |
$6,517.15
|
| Rate for Payer: United Healthcare All Payer |
$5,974.06
|
|
|
ATRICULEZE M HEAD 36MM +12
|
Facility
|
OP
|
$6,788.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,036.61 |
| Max. Negotiated Rate |
$6,517.15 |
| Rate for Payer: Aetna Commercial |
$5,227.30
|
| Rate for Payer: Anthem Medicaid |
$2,334.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.19
|
| Rate for Payer: Cash Price |
$3,394.35
|
| Rate for Payer: Cigna Commercial |
$5,634.62
|
| Rate for Payer: First Health Commercial |
$6,449.27
|
| Rate for Payer: Humana Commercial |
$5,770.40
|
| Rate for Payer: Humana KY Medicaid |
$2,334.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,566.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,091.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,430.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,906.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,684.20
|
| Rate for Payer: PHCS Commercial |
$6,517.15
|
| Rate for Payer: United Healthcare All Payer |
$5,974.06
|
|
|
ATRICULEZE M HEAD 36MM +15.5
|
Facility
|
IP
|
$5,714.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.42 |
| Max. Negotiated Rate |
$5,486.16 |
| Rate for Payer: Aetna Commercial |
$4,400.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,457.51
|
| Rate for Payer: Cash Price |
$2,857.38
|
| Rate for Payer: Cigna Commercial |
$4,743.24
|
| Rate for Payer: First Health Commercial |
$5,429.01
|
| Rate for Payer: Humana Commercial |
$4,857.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,686.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,217.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,714.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,028.98
|
| Rate for Payer: Ohio Health Group HMO |
$4,286.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,571.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,971.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,943.18
|
| Rate for Payer: PHCS Commercial |
$5,486.16
|
| Rate for Payer: United Healthcare All Payer |
$5,028.98
|
|
|
ATRICULEZE M HEAD 36MM +15.5
|
Facility
|
OP
|
$5,714.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.42 |
| Max. Negotiated Rate |
$5,486.16 |
| Rate for Payer: Aetna Commercial |
$4,400.36
|
| Rate for Payer: Anthem Medicaid |
$1,965.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,457.51
|
| Rate for Payer: Cash Price |
$2,857.38
|
| Rate for Payer: Cigna Commercial |
$4,743.24
|
| Rate for Payer: First Health Commercial |
$5,429.01
|
| Rate for Payer: Humana Commercial |
$4,857.54
|
| Rate for Payer: Humana KY Medicaid |
$1,965.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,985.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,686.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,217.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,714.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,004.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,028.98
|
| Rate for Payer: Ohio Health Group HMO |
$4,286.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,571.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,971.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,943.18
|
| Rate for Payer: PHCS Commercial |
$5,486.16
|
| Rate for Payer: United Healthcare All Payer |
$5,028.98
|
|
|
ATRICULEZE M HEAD 36MM +8.5
|
Facility
|
IP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ATRICULEZE M HEAD 36MM +8.5
|
Facility
|
OP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem Medicaid |
$1,558.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Humana KY Medicaid |
$1,558.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ATRIPLA TABLET
|
Facility
|
OP
|
$171.82
|
|
|
Service Code
|
NDC 15584010101
|
| Hospital Charge Code |
25000279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$164.95 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Anthem Medicaid |
$59.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.02
|
| Rate for Payer: Cash Price |
$85.91
|
| Rate for Payer: Cigna Commercial |
$142.61
|
| Rate for Payer: First Health Commercial |
$163.23
|
| Rate for Payer: Humana Commercial |
$146.05
|
| Rate for Payer: Humana KY Medicaid |
$59.09
|
| Rate for Payer: Kentucky WC Medicaid |
$59.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.20
|
| Rate for Payer: Ohio Health Group HMO |
$128.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.56
|
| Rate for Payer: PHCS Commercial |
$164.95
|
| Rate for Payer: United Healthcare All Payer |
$151.20
|
|
|
ATRIPLA TABLET
|
Facility
|
IP
|
$171.82
|
|
|
Service Code
|
NDC 15584010101
|
| Hospital Charge Code |
25000279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$164.95 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.02
|
| Rate for Payer: Cash Price |
$85.91
|
| Rate for Payer: Cigna Commercial |
$142.61
|
| Rate for Payer: First Health Commercial |
$163.23
|
| Rate for Payer: Humana Commercial |
$146.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.20
|
| Rate for Payer: Ohio Health Group HMO |
$128.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.56
|
| Rate for Payer: PHCS Commercial |
$164.95
|
| Rate for Payer: United Healthcare All Payer |
$151.20
|
|
|
ATROPINE 0.01MG(0.25MG/5ML)SYR
|
Facility
|
IP
|
$127.38
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001880
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.21 |
| Max. Negotiated Rate |
$122.28 |
| Rate for Payer: Aetna Commercial |
$98.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.36
|
| Rate for Payer: Cash Price |
$63.69
|
| Rate for Payer: Cigna Commercial |
$105.73
|
| Rate for Payer: First Health Commercial |
$121.01
|
| Rate for Payer: Humana Commercial |
$108.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.09
|
| Rate for Payer: Ohio Health Group HMO |
$95.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.89
|
| Rate for Payer: PHCS Commercial |
$122.28
|
| Rate for Payer: United Healthcare All Payer |
$112.09
|
|
|
ATROPINE 0.01MG(0.25MG/5ML)SYR
|
Facility
|
OP
|
$127.38
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001880
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.21 |
| Max. Negotiated Rate |
$122.28 |
| Rate for Payer: Aetna Commercial |
$98.08
|
| Rate for Payer: Anthem Medicaid |
$43.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.36
|
| Rate for Payer: Cash Price |
$63.69
|
| Rate for Payer: Cigna Commercial |
$105.73
|
| Rate for Payer: First Health Commercial |
$121.01
|
| Rate for Payer: Humana Commercial |
$108.27
|
| Rate for Payer: Humana KY Medicaid |
$43.81
|
| Rate for Payer: Kentucky WC Medicaid |
$44.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.09
|
| Rate for Payer: Ohio Health Group HMO |
$95.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.89
|
| Rate for Payer: PHCS Commercial |
$122.28
|
| Rate for Payer: United Healthcare All Payer |
$112.09
|
|
|
ATROPINE 0.01MG(1 MG/10 ML)SYR
|
Facility
|
OP
|
$115.49
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$110.87 |
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: Anthem Medicaid |
$39.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.08
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cigna Commercial |
$95.86
|
| Rate for Payer: First Health Commercial |
$109.72
|
| Rate for Payer: Humana Commercial |
$98.17
|
| Rate for Payer: Humana KY Medicaid |
$39.72
|
| Rate for Payer: Kentucky WC Medicaid |
$40.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.63
|
| Rate for Payer: Ohio Health Group HMO |
$86.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.69
|
| Rate for Payer: PHCS Commercial |
$110.87
|
| Rate for Payer: United Healthcare All Payer |
$101.63
|
|
|
ATROPINE 0.01MG(1 MG/10 ML)SYR
|
Facility
|
IP
|
$115.49
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001881
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$110.87 |
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.08
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cigna Commercial |
$95.86
|
| Rate for Payer: First Health Commercial |
$109.72
|
| Rate for Payer: Humana Commercial |
$98.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.63
|
| Rate for Payer: Ohio Health Group HMO |
$86.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.69
|
| Rate for Payer: PHCS Commercial |
$110.87
|
| Rate for Payer: United Healthcare All Payer |
$101.63
|
|
|
ATROPINE 0.5 MG/5 ML SYRINGE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25004053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem Medicaid |
$39.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.48
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Humana KY Medicaid |
$39.89
|
| Rate for Payer: Kentucky WC Medicaid |
$40.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.04
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
ATROPINE 0.5 MG/5 ML SYRINGE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25004053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.48
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.04
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
ATROPINE 1% EYE DROPS
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
NDC 60219174802
|
| Hospital Charge Code |
25002855
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
ATROPINE 1% EYE DROPS
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
NDC 60219174802
|
| Hospital Charge Code |
25002855
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.22
|
| Rate for Payer: PHCS Commercial |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
ATROPINE 1% EYE DROPS 5ML
|
Facility
|
IP
|
$1.95
|
|
|
Service Code
|
NDC 60219174903
|
| Hospital Charge Code |
25002857
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.52
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna Commercial |
$1.62
|
| Rate for Payer: First Health Commercial |
$1.85
|
| Rate for Payer: Humana Commercial |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.72
|
| Rate for Payer: Ohio Health Group HMO |
$1.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Payer |
$1.72
|
|
|
ATROPINE 1% EYE DROPS 5ML
|
Facility
|
OP
|
$1.95
|
|
|
Service Code
|
NDC 60219174903
|
| Hospital Charge Code |
25002857
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Anthem Medicaid |
$0.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.52
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna Commercial |
$1.62
|
| Rate for Payer: First Health Commercial |
$1.85
|
| Rate for Payer: Humana Commercial |
$1.66
|
| Rate for Payer: Humana KY Medicaid |
$0.67
|
| Rate for Payer: Kentucky WC Medicaid |
$0.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.72
|
| Rate for Payer: Ohio Health Group HMO |
$1.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$1.87
|
| Rate for Payer: United Healthcare All Payer |
$1.72
|
|
|
ATROPINE RT 0.01MG (0.4MG/ML)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001883
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
ATROPINE RT 0.01MG (0.4MG/ML)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001883
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$39.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$39.55
|
| Rate for Payer: Kentucky WC Medicaid |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
ATROPINE RT 0.01 MG[1MG/ML VL]
|
Facility
|
IP
|
$119.56
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001882
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.87 |
| Max. Negotiated Rate |
$114.78 |
| Rate for Payer: Aetna Commercial |
$92.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.26
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cigna Commercial |
$99.23
|
| Rate for Payer: First Health Commercial |
$113.58
|
| Rate for Payer: Humana Commercial |
$101.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.21
|
| Rate for Payer: Ohio Health Group HMO |
$89.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.50
|
| Rate for Payer: PHCS Commercial |
$114.78
|
| Rate for Payer: United Healthcare All Payer |
$105.21
|
|
|
ATROPINE RT 0.01 MG[1MG/ML VL]
|
Facility
|
OP
|
$119.56
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
25001882
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.87 |
| Max. Negotiated Rate |
$114.78 |
| Rate for Payer: Aetna Commercial |
$92.06
|
| Rate for Payer: Anthem Medicaid |
$41.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.26
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: Cigna Commercial |
$99.23
|
| Rate for Payer: First Health Commercial |
$113.58
|
| Rate for Payer: Humana Commercial |
$101.63
|
| Rate for Payer: Humana KY Medicaid |
$41.12
|
| Rate for Payer: Kentucky WC Medicaid |
$41.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.21
|
| Rate for Payer: Ohio Health Group HMO |
$89.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.50
|
| Rate for Payer: PHCS Commercial |
$114.78
|
| Rate for Payer: United Healthcare All Payer |
$105.21
|
|
|
ATROVENT (IPRATOPIUM) 15ML
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
NDC 24208039915
|
| Hospital Charge Code |
25000280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Anthem Medicaid |
$0.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.89
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna Commercial |
$0.95
|
| Rate for Payer: First Health Commercial |
$1.08
|
| Rate for Payer: Humana Commercial |
$0.97
|
| Rate for Payer: Humana KY Medicaid |
$0.39
|
| Rate for Payer: Kentucky WC Medicaid |
$0.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.00
|
| Rate for Payer: Ohio Health Group HMO |
$0.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.79
|
| Rate for Payer: PHCS Commercial |
$1.09
|
| Rate for Payer: United Healthcare All Payer |
$1.00
|
|
