|
STRATTERA 18MG EQUIV CAPSULE
|
Facility
|
OP
|
$9.63
|
|
|
Service Code
|
NDC 64980037403
|
| Hospital Charge Code |
25003497
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$9.24 |
| Rate for Payer: Aetna Commercial |
$7.42
|
| Rate for Payer: Anthem Medicaid |
$3.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.51
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cigna Commercial |
$7.99
|
| Rate for Payer: First Health Commercial |
$9.15
|
| Rate for Payer: Humana Commercial |
$8.19
|
| Rate for Payer: Humana KY Medicaid |
$3.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.47
|
| Rate for Payer: Ohio Health Group HMO |
$7.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.64
|
| Rate for Payer: PHCS Commercial |
$9.24
|
| Rate for Payer: United Healthcare All Payer |
$8.47
|
|
|
STRATTERA 18MG EQUIV CAPSULE
|
Facility
|
IP
|
$9.63
|
|
|
Service Code
|
NDC 64980037403
|
| Hospital Charge Code |
25003497
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$9.24 |
| Rate for Payer: Aetna Commercial |
$7.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.51
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cigna Commercial |
$7.99
|
| Rate for Payer: First Health Commercial |
$9.15
|
| Rate for Payer: Humana Commercial |
$8.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.47
|
| Rate for Payer: Ohio Health Group HMO |
$7.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.64
|
| Rate for Payer: PHCS Commercial |
$9.24
|
| Rate for Payer: United Healthcare All Payer |
$8.47
|
|
|
STRATTERA 80MG EQUIV CAPSULE
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 64980037803
|
| Hospital Charge Code |
25003498
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.73
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cigna Commercial |
$8.23
|
| Rate for Payer: First Health Commercial |
$9.41
|
| Rate for Payer: Humana Commercial |
$8.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.72
|
| Rate for Payer: Ohio Health Group HMO |
$7.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.84
|
| Rate for Payer: PHCS Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Payer |
$8.72
|
|
|
STRATTERA 80MG EQUIV CAPSULE
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 64980037803
|
| Hospital Charge Code |
25003498
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: Anthem Medicaid |
$3.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.73
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cigna Commercial |
$8.23
|
| Rate for Payer: First Health Commercial |
$9.41
|
| Rate for Payer: Humana Commercial |
$8.42
|
| Rate for Payer: Humana KY Medicaid |
$3.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.72
|
| Rate for Payer: Ohio Health Group HMO |
$7.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.84
|
| Rate for Payer: PHCS Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Payer |
$8.72
|
|
|
STRATTERA(ATOMOXETINE)25MG CAP
|
Facility
|
IP
|
$30.18
|
|
|
Service Code
|
NDC 2322830
|
| Hospital Charge Code |
25001437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$28.97 |
| Rate for Payer: Aetna Commercial |
$23.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.54
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cigna Commercial |
$25.05
|
| Rate for Payer: First Health Commercial |
$28.67
|
| Rate for Payer: Humana Commercial |
$25.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.56
|
| Rate for Payer: Ohio Health Group HMO |
$22.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.82
|
| Rate for Payer: PHCS Commercial |
$28.97
|
| Rate for Payer: United Healthcare All Payer |
$26.56
|
|
|
STRATTERA(ATOMOXETINE)25MG CAP
|
Facility
|
OP
|
$30.18
|
|
|
Service Code
|
NDC 2322830
|
| Hospital Charge Code |
25001437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$28.97 |
| Rate for Payer: Aetna Commercial |
$23.24
|
| Rate for Payer: Anthem Medicaid |
$10.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.54
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cigna Commercial |
$25.05
|
| Rate for Payer: First Health Commercial |
$28.67
|
| Rate for Payer: Humana Commercial |
$25.65
|
| Rate for Payer: Humana KY Medicaid |
$10.38
|
| Rate for Payer: Kentucky WC Medicaid |
$10.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.56
|
| Rate for Payer: Ohio Health Group HMO |
$22.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.82
|
| Rate for Payer: PHCS Commercial |
$28.97
|
| Rate for Payer: United Healthcare All Payer |
$26.56
|
|
|
STRATTERA(ATOMOXETINE)40MG CAP
|
Facility
|
OP
|
$9.74
|
|
|
Service Code
|
NDC 68462026830
|
| Hospital Charge Code |
25001438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Aetna Commercial |
$7.50
|
| Rate for Payer: Anthem Medicaid |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.60
|
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: Cigna Commercial |
$8.08
|
| Rate for Payer: First Health Commercial |
$9.25
|
| Rate for Payer: Humana Commercial |
$8.28
|
| Rate for Payer: Humana KY Medicaid |
$3.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.57
|
| Rate for Payer: Ohio Health Group HMO |
$7.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.72
|
| Rate for Payer: PHCS Commercial |
$9.35
|
| Rate for Payer: United Healthcare All Payer |
$8.57
|
|
|
STRATTERA(ATOMOXETINE)40MG CAP
|
Facility
|
IP
|
$9.74
|
|
|
Service Code
|
NDC 68462026830
|
| Hospital Charge Code |
25001438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Aetna Commercial |
$7.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.60
|
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: Cigna Commercial |
$8.08
|
| Rate for Payer: First Health Commercial |
$9.25
|
| Rate for Payer: Humana Commercial |
$8.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.57
|
| Rate for Payer: Ohio Health Group HMO |
$7.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.72
|
| Rate for Payer: PHCS Commercial |
$9.35
|
| Rate for Payer: United Healthcare All Payer |
$8.57
|
|
|
STRATTERA(ATOMOXETINE)60MG CAP
|
Facility
|
IP
|
$31.32
|
|
|
Service Code
|
NDC 2323930
|
| Hospital Charge Code |
25001439
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Aetna Commercial |
$24.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.43
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: First Health Commercial |
$29.75
|
| Rate for Payer: Humana Commercial |
$26.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.56
|
| Rate for Payer: Ohio Health Group HMO |
$23.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.61
|
| Rate for Payer: PHCS Commercial |
$30.07
|
| Rate for Payer: United Healthcare All Payer |
$27.56
|
|
|
STRATTERA(ATOMOXETINE)60MG CAP
|
Facility
|
OP
|
$31.32
|
|
|
Service Code
|
NDC 2323930
|
| Hospital Charge Code |
25001439
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Aetna Commercial |
$24.12
|
| Rate for Payer: Anthem Medicaid |
$10.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.43
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cigna Commercial |
$26.00
|
| Rate for Payer: First Health Commercial |
$29.75
|
| Rate for Payer: Humana Commercial |
$26.62
|
| Rate for Payer: Humana KY Medicaid |
$10.77
|
| Rate for Payer: Kentucky WC Medicaid |
$10.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.56
|
| Rate for Payer: Ohio Health Group HMO |
$23.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.61
|
| Rate for Payer: PHCS Commercial |
$30.07
|
| Rate for Payer: United Healthcare All Payer |
$27.56
|
|
|
STRAVIX 2.0CM X 4.0CM
|
Facility
|
OP
|
$9,588.25
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
27000274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem Medicaid |
$3,297.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Humana KY Medicaid |
$3,297.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,330.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
STRAVIX 2.0CM X 4.0CM
|
Facility
|
IP
|
$9,588.25
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
27000274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
STRAVIX PL 2 CM X 2 CM
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
27000274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
STRAVIX PL 2 CM X 2 CM
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
27000274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
STRAVIX PL 2 CM X 4 CM
|
Facility
|
IP
|
$9,588.25
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
27000274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
STRAVIX PL 2 CM X 4 CM
|
Facility
|
OP
|
$9,588.25
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
27000274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem Medicaid |
$3,297.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Humana KY Medicaid |
$3,297.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,330.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
STRAVIX PL 3 CM X 6 CM
|
Facility
|
IP
|
$13,776.00
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
27000274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
STRAVIX PL 3 CM X 6 CM
|
Facility
|
OP
|
$13,776.00
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
27000274
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem Medicaid |
$4,737.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Humana KY Medicaid |
$4,737.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,785.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
STREP AGALACTIAE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001296
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
STREP AGALACTIAE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001296
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
STREP ANGLOSUS GYRB GENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001292
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
STREP ANGLOSUS GYRB GENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001292
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
STREP PNEUMO GYRB GENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001288
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
STREP PNEUMO GYRB GENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001288
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
STREP PYOGENES HSP60 GENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
