|
ACETABULAR LINER 32ID58-60ODW
|
Facility
|
OP
|
$8,885.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.11 |
| Max. Negotiated Rate |
$8,530.04 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Anthem Medicaid |
$3,055.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,930.66
|
| Rate for Payer: Cash Price |
$4,442.73
|
| Rate for Payer: Cigna Commercial |
$7,374.93
|
| Rate for Payer: First Health Commercial |
$8,441.19
|
| Rate for Payer: Humana Commercial |
$7,552.64
|
| Rate for Payer: Humana KY Medicaid |
$3,055.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,086.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,286.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,557.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,665.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,117.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,664.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,754.49
|
| Rate for Payer: PHCS Commercial |
$8,530.04
|
| Rate for Payer: United Healthcare All Payer |
$7,819.20
|
|
|
ACETABULAR LINER 44MMX56MM
|
Facility
|
IP
|
$20,002.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.29 |
| Max. Negotiated Rate |
$19,202.16 |
| Rate for Payer: Aetna Commercial |
$15,401.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,601.76
|
| Rate for Payer: Cash Price |
$10,001.12
|
| Rate for Payer: Cigna Commercial |
$16,601.87
|
| Rate for Payer: First Health Commercial |
$19,002.14
|
| Rate for Payer: Humana Commercial |
$17,001.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,401.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,761.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,601.98
|
| Rate for Payer: Ohio Health Group HMO |
$15,001.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,600.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.70
|
| Rate for Payer: PHCS Commercial |
$19,202.16
|
| Rate for Payer: United Healthcare All Payer |
$17,601.98
|
|
|
ACETABULAR LINER 44MMX56MM
|
Facility
|
OP
|
$20,002.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.29 |
| Max. Negotiated Rate |
$19,202.16 |
| Rate for Payer: Aetna Commercial |
$15,401.73
|
| Rate for Payer: Anthem Medicaid |
$6,878.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,601.76
|
| Rate for Payer: Cash Price |
$10,001.12
|
| Rate for Payer: Cigna Commercial |
$16,601.87
|
| Rate for Payer: First Health Commercial |
$19,002.14
|
| Rate for Payer: Humana Commercial |
$17,001.91
|
| Rate for Payer: Humana KY Medicaid |
$6,878.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,401.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,761.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,601.98
|
| Rate for Payer: Ohio Health Group HMO |
$15,001.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,600.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.70
|
| Rate for Payer: PHCS Commercial |
$19,202.16
|
| Rate for Payer: United Healthcare All Payer |
$17,601.98
|
|
|
ACETABULAR LINER 48MMX60MM
|
Facility
|
OP
|
$20,002.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.29 |
| Max. Negotiated Rate |
$19,202.16 |
| Rate for Payer: Aetna Commercial |
$15,401.73
|
| Rate for Payer: Anthem Medicaid |
$6,878.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,601.76
|
| Rate for Payer: Cash Price |
$10,001.12
|
| Rate for Payer: Cigna Commercial |
$16,601.87
|
| Rate for Payer: First Health Commercial |
$19,002.14
|
| Rate for Payer: Humana Commercial |
$17,001.91
|
| Rate for Payer: Humana KY Medicaid |
$6,878.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,401.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,761.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,601.98
|
| Rate for Payer: Ohio Health Group HMO |
$15,001.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,600.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.70
|
| Rate for Payer: PHCS Commercial |
$19,202.16
|
| Rate for Payer: United Healthcare All Payer |
$17,601.98
|
|
|
ACETABULAR LINER 48MMX60MM
|
Facility
|
IP
|
$20,002.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.29 |
| Max. Negotiated Rate |
$19,202.16 |
| Rate for Payer: Aetna Commercial |
$15,401.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,601.76
|
| Rate for Payer: Cash Price |
$10,001.12
|
| Rate for Payer: Cigna Commercial |
$16,601.87
|
| Rate for Payer: First Health Commercial |
$19,002.14
|
| Rate for Payer: Humana Commercial |
$17,001.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,401.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,761.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,601.98
|
| Rate for Payer: Ohio Health Group HMO |
$15,001.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,600.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.70
|
| Rate for Payer: PHCS Commercial |
$19,202.16
|
| Rate for Payer: United Healthcare All Payer |
$17,601.98
|
|
|
ACETABULAR R3 LINER
|
Facility
|
IP
|
$20,002.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.29 |
| Max. Negotiated Rate |
$19,202.16 |
| Rate for Payer: Aetna Commercial |
$15,401.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,601.76
|
| Rate for Payer: Cash Price |
$10,001.12
|
| Rate for Payer: Cigna Commercial |
$16,601.87
|
| Rate for Payer: First Health Commercial |
$19,002.14
|
| Rate for Payer: Humana Commercial |
$17,001.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,401.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,761.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,601.98
|
| Rate for Payer: Ohio Health Group HMO |
$15,001.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,600.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.70
|
| Rate for Payer: PHCS Commercial |
$19,202.16
|
| Rate for Payer: United Healthcare All Payer |
$17,601.98
|
|
|
ACETABULAR R3 LINER
|
Facility
|
OP
|
$20,002.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.29 |
| Max. Negotiated Rate |
$19,202.16 |
| Rate for Payer: Aetna Commercial |
$15,401.73
|
| Rate for Payer: Anthem Medicaid |
$6,878.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,601.76
|
| Rate for Payer: Cash Price |
$10,001.12
|
| Rate for Payer: Cigna Commercial |
$16,601.87
|
| Rate for Payer: First Health Commercial |
$19,002.14
|
| Rate for Payer: Humana Commercial |
$17,001.91
|
| Rate for Payer: Humana KY Medicaid |
$6,878.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,401.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,761.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,601.98
|
| Rate for Payer: Ohio Health Group HMO |
$15,001.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,600.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.70
|
| Rate for Payer: PHCS Commercial |
$19,202.16
|
| Rate for Payer: United Healthcare All Payer |
$17,601.98
|
|
|
ACETADOTE 100MG 6GM/30ML VIAL
|
Facility
|
IP
|
$615.50
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
25001823
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.02 |
| Max. Negotiated Rate |
$590.88 |
| Rate for Payer: Aetna Commercial |
$473.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$480.09
|
| Rate for Payer: Cash Price |
$307.75
|
| Rate for Payer: Cigna Commercial |
$510.86
|
| Rate for Payer: First Health Commercial |
$584.72
|
| Rate for Payer: Humana Commercial |
$523.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$454.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.64
|
| Rate for Payer: Ohio Health Group HMO |
$461.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.80
|
| Rate for Payer: PHCS Commercial |
$590.88
|
| Rate for Payer: United Healthcare All Payer |
$541.64
|
|
|
ACETADOTE 100MG 6GM/30ML VIAL
|
Facility
|
OP
|
$615.50
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
25001823
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.02 |
| Max. Negotiated Rate |
$590.88 |
| Rate for Payer: Aetna Commercial |
$473.94
|
| Rate for Payer: Anthem Medicaid |
$211.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$480.09
|
| Rate for Payer: Cash Price |
$307.75
|
| Rate for Payer: Cigna Commercial |
$510.86
|
| Rate for Payer: First Health Commercial |
$584.72
|
| Rate for Payer: Humana Commercial |
$523.18
|
| Rate for Payer: Humana KY Medicaid |
$211.67
|
| Rate for Payer: Kentucky WC Medicaid |
$213.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$454.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$215.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.64
|
| Rate for Payer: Ohio Health Group HMO |
$461.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.80
|
| Rate for Payer: PHCS Commercial |
$590.88
|
| Rate for Payer: United Healthcare All Payer |
$541.64
|
|
|
ACETAMIN (BBRAUN) 10MG(500MG)
|
Facility
|
IP
|
$33.46
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
25004436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$32.12 |
| Rate for Payer: Aetna Commercial |
$25.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.10
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna Commercial |
$27.77
|
| Rate for Payer: First Health Commercial |
$31.79
|
| Rate for Payer: Humana Commercial |
$28.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.44
|
| Rate for Payer: Ohio Health Group HMO |
$25.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.37
|
| Rate for Payer: PHCS Commercial |
$32.12
|
| Rate for Payer: United Healthcare All Payer |
$29.44
|
|
|
ACETAMIN (BBRAUN) 10MG(500MG)
|
Facility
|
OP
|
$33.46
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
25004436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$32.12 |
| Rate for Payer: Aetna Commercial |
$25.76
|
| Rate for Payer: Anthem Medicaid |
$11.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.08
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna Commercial |
$27.77
|
| Rate for Payer: First Health Commercial |
$31.79
|
| Rate for Payer: Humana Commercial |
$28.44
|
| Rate for Payer: Humana KY Medicaid |
$11.51
|
| Rate for Payer: Humana Medicare Advantage |
$0.06
|
| Rate for Payer: Kentucky WC Medicaid |
$11.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.44
|
| Rate for Payer: Ohio Health Group HMO |
$25.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.37
|
| Rate for Payer: PHCS Commercial |
$32.12
|
| Rate for Payer: United Healthcare All Payer |
$29.44
|
|
|
ACETAMIN(GENERIC)10MG(1000MG)
|
Facility
|
IP
|
$51.78
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
25001822
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$49.71 |
| Rate for Payer: Aetna Commercial |
$39.87
|
| Rate for Payer: Aetna Commercial |
$50.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.01
|
| Rate for Payer: Cash Price |
$25.89
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$42.98
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: First Health Commercial |
$62.13
|
| Rate for Payer: First Health Commercial |
$49.19
|
| Rate for Payer: Humana Commercial |
$55.59
|
| Rate for Payer: Humana Commercial |
$44.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.55
|
| Rate for Payer: Ohio Health Group HMO |
$38.84
|
| Rate for Payer: Ohio Health Group HMO |
$49.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.05
|
| Rate for Payer: PHCS Commercial |
$49.71
|
| Rate for Payer: PHCS Commercial |
$62.78
|
| Rate for Payer: United Healthcare All Payer |
$45.57
|
| Rate for Payer: United Healthcare All Payer |
$57.55
|
|
|
ACETAMIN(GENERIC)10MG(1000MG)
|
Facility
|
OP
|
$51.78
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
25001822
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$49.71 |
| Rate for Payer: Aetna Commercial |
$39.87
|
| Rate for Payer: Aetna Commercial |
$50.36
|
| Rate for Payer: Anthem Medicaid |
$17.81
|
| Rate for Payer: Anthem Medicaid |
$22.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.01
|
| Rate for Payer: Cash Price |
$25.89
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Cigna Commercial |
$42.98
|
| Rate for Payer: First Health Commercial |
$62.13
|
| Rate for Payer: First Health Commercial |
$49.19
|
| Rate for Payer: Humana Commercial |
$44.01
|
| Rate for Payer: Humana Commercial |
$55.59
|
| Rate for Payer: Humana KY Medicaid |
$17.81
|
| Rate for Payer: Humana KY Medicaid |
$22.49
|
| Rate for Payer: Kentucky WC Medicaid |
$22.72
|
| Rate for Payer: Kentucky WC Medicaid |
$17.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.55
|
| Rate for Payer: Ohio Health Group HMO |
$38.84
|
| Rate for Payer: Ohio Health Group HMO |
$49.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.27
|
| Rate for Payer: PHCS Commercial |
$62.78
|
| Rate for Payer: PHCS Commercial |
$49.71
|
| Rate for Payer: United Healthcare All Payer |
$57.55
|
| Rate for Payer: United Healthcare All Payer |
$45.57
|
|
|
ACETAMIN (OFIRMEV)10MG(1000MG)
|
Facility
|
IP
|
$2.49
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.94
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna Commercial |
$2.07
|
| Rate for Payer: First Health Commercial |
$2.37
|
| Rate for Payer: Humana Commercial |
$2.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.19
|
| Rate for Payer: Ohio Health Group HMO |
$1.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.77
|
| Rate for Payer: PHCS Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Payer |
$2.19
|
|
|
ACETAMIN (OFIRMEV)10MG(1000MG)
|
Facility
|
OP
|
$2.49
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: Anthem Medicaid |
$0.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.94
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna Commercial |
$2.07
|
| Rate for Payer: First Health Commercial |
$2.37
|
| Rate for Payer: Humana Commercial |
$2.12
|
| Rate for Payer: Humana KY Medicaid |
$0.86
|
| Rate for Payer: Kentucky WC Medicaid |
$0.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.19
|
| Rate for Payer: Ohio Health Group HMO |
$1.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.77
|
| Rate for Payer: PHCS Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Payer |
$2.19
|
|
|
ACETAMIN (OFIRMEV)10MG(1000MG)
|
Facility
|
IP
|
$2.49
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
636T0008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.94
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna Commercial |
$2.07
|
| Rate for Payer: First Health Commercial |
$2.37
|
| Rate for Payer: Humana Commercial |
$2.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.19
|
| Rate for Payer: Ohio Health Group HMO |
$1.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.77
|
| Rate for Payer: PHCS Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Payer |
$2.19
|
|
|
ACETAMIN (OFIRMEV)10MG(1000MG)
|
Professional
|
Both
|
$2.49
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna Commercial |
$0.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.49
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Multiplan PHCS |
$1.49
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1.74
|
| Rate for Payer: UHCCP Medicaid |
$0.87
|
|
|
ACETAMIN (OFIRMEV)10MG(1000MG)
|
Facility
|
OP
|
$2.49
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
636T0008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: Anthem Medicaid |
$0.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.94
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna Commercial |
$2.07
|
| Rate for Payer: First Health Commercial |
$2.37
|
| Rate for Payer: Humana Commercial |
$2.12
|
| Rate for Payer: Humana KY Medicaid |
$0.86
|
| Rate for Payer: Kentucky WC Medicaid |
$0.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.19
|
| Rate for Payer: Ohio Health Group HMO |
$1.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.77
|
| Rate for Payer: PHCS Commercial |
$2.39
|
| Rate for Payer: United Healthcare All Payer |
$2.19
|
|
|
ACETAMINOPHEN (TYLENOL)
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 80143
|
| Hospital Charge Code |
30000070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
ACETAMINOPHEN (TYLENOL)
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 80143
|
| Hospital Charge Code |
30000070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$18.64
|
| Rate for Payer: Humana Medicare Advantage |
$18.64
|
| Rate for Payer: Kentucky WC Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
ACETASOL(ACTICACIDHC)2%SOL10ML
|
Facility
|
IP
|
$2.77
|
|
|
Service Code
|
NDC 51672300701
|
| Hospital Charge Code |
25000142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.16
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cigna Commercial |
$2.30
|
| Rate for Payer: First Health Commercial |
$2.63
|
| Rate for Payer: Humana Commercial |
$2.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.44
|
| Rate for Payer: Ohio Health Group HMO |
$2.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.86
|
| Rate for Payer: PHCS Commercial |
$2.66
|
| Rate for Payer: United Healthcare All Payer |
$2.44
|
|
|
ACETASOL(ACTICACIDHC)2%SOL10ML
|
Facility
|
OP
|
$2.77
|
|
|
Service Code
|
NDC 51672300701
|
| Hospital Charge Code |
25000142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.13
|
| Rate for Payer: Anthem Medicaid |
$0.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.16
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cigna Commercial |
$2.30
|
| Rate for Payer: First Health Commercial |
$2.63
|
| Rate for Payer: Humana Commercial |
$2.35
|
| Rate for Payer: Humana KY Medicaid |
$0.95
|
| Rate for Payer: Kentucky WC Medicaid |
$0.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.44
|
| Rate for Payer: Ohio Health Group HMO |
$2.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.86
|
| Rate for Payer: PHCS Commercial |
$2.66
|
| Rate for Payer: United Healthcare All Payer |
$2.44
|
|
|
ACETIC ACID 0.25% 250mL BOTTLE
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
NDC 990614322
|
| Hospital Charge Code |
25004001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Anthem Medicaid |
$7.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.36
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: First Health Commercial |
$21.14
|
| Rate for Payer: Humana Commercial |
$18.91
|
| Rate for Payer: Humana KY Medicaid |
$7.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.58
|
| Rate for Payer: Ohio Health Group HMO |
$16.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
ACETIC ACID 0.25% 250mL BOTTLE
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
NDC 990614322
|
| Hospital Charge Code |
25004001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.36
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: First Health Commercial |
$21.14
|
| Rate for Payer: Humana Commercial |
$18.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.58
|
| Rate for Payer: Ohio Health Group HMO |
$16.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
ACETIC ACID 0.25% AQUEOUS 8 OZ
|
Facility
|
OP
|
$768.75
|
|
| Hospital Charge Code |
25002798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.94 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$591.94
|
| Rate for Payer: Anthem Medicaid |
$264.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.62
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Cigna Commercial |
$638.06
|
| Rate for Payer: First Health Commercial |
$730.31
|
| Rate for Payer: Humana Commercial |
$653.44
|
| Rate for Payer: Humana KY Medicaid |
$264.37
|
| Rate for Payer: Kentucky WC Medicaid |
$267.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$630.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$567.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$676.50
|
| Rate for Payer: Ohio Health Group HMO |
$576.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.31
|
| Rate for Payer: PHCS Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Payer |
$676.50
|
|
