|
BETA-HYDROXYBUTYRATE
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
30001828
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$59.52 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.79
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna Commercial |
$51.46
|
| Rate for Payer: First Health Commercial |
$58.90
|
| Rate for Payer: Humana Commercial |
$52.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.56
|
| Rate for Payer: Ohio Health Group HMO |
$46.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.78
|
| Rate for Payer: PHCS Commercial |
$59.52
|
| Rate for Payer: United Healthcare All Payer |
$54.56
|
|
|
BETA-HYDROXYBUTYRATE
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
30001828
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$59.52 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.17
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cash Price |
$31.00
|
| Rate for Payer: Cigna Commercial |
$51.46
|
| Rate for Payer: First Health Commercial |
$58.90
|
| Rate for Payer: Humana Commercial |
$52.70
|
| Rate for Payer: Humana KY Medicaid |
$8.17
|
| Rate for Payer: Humana Medicare Advantage |
$8.17
|
| Rate for Payer: Kentucky WC Medicaid |
$8.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.56
|
| Rate for Payer: Ohio Health Group HMO |
$46.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.78
|
| Rate for Payer: PHCS Commercial |
$59.52
|
| Rate for Payer: United Healthcare All Payer |
$54.56
|
|
|
BETA LACTAMASE
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
30001321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem Medicaid |
$4.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.75
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| Rate for Payer: Humana KY Medicaid |
$4.75
|
| Rate for Payer: Humana Medicare Advantage |
$4.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.81
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
BETA LACTAMASE
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
30001321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.35
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.81
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
BETAPACE (SOTALOL) 80 MG
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 50268072415
|
| Hospital Charge Code |
25000332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
BETAPACE (SOTALOL) 80 MG
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 50268072415
|
| Hospital Charge Code |
25000332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
BETAPACE (SOTALOL HCL) 120MG T
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 50268072515
|
| Hospital Charge Code |
25000331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
BETAPACE (SOTALOL HCL) 120MG T
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 50268072515
|
| Hospital Charge Code |
25000331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
BETA SUB QUALITATIVE HC6 URINE
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
30000179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Ambetter Exchange |
$8.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.33
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$8.82
|
| Rate for Payer: Healthspan PPO |
$6.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.61
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.19
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.61
|
|
|
BETA SUB QUALITATIVE HC6 URINE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
30000179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$8.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.61
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$8.61
|
| Rate for Payer: Humana Medicare Advantage |
$8.61
|
| Rate for Payer: Kentucky WC Medicaid |
$8.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
BETA SUB QUALITATIVE HC6 URINE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
30000179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.13
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
BETAXOLOL 20MG TABLET
|
Facility
|
OP
|
$9.32
|
|
|
Service Code
|
NDC 10702001401
|
| Hospital Charge Code |
25000335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Anthem Medicaid |
$3.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.27
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna Commercial |
$7.74
|
| Rate for Payer: First Health Commercial |
$8.85
|
| Rate for Payer: Humana Commercial |
$7.92
|
| Rate for Payer: Humana KY Medicaid |
$3.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.20
|
| Rate for Payer: Ohio Health Group HMO |
$6.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.43
|
| Rate for Payer: PHCS Commercial |
$8.95
|
| Rate for Payer: United Healthcare All Payer |
$8.20
|
|
|
BETAXOLOL 20MG TABLET
|
Facility
|
IP
|
$9.32
|
|
|
Service Code
|
NDC 10702001401
|
| Hospital Charge Code |
25000335
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$8.95 |
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.27
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cigna Commercial |
$7.74
|
| Rate for Payer: First Health Commercial |
$8.85
|
| Rate for Payer: Humana Commercial |
$7.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.20
|
| Rate for Payer: Ohio Health Group HMO |
$6.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.43
|
| Rate for Payer: PHCS Commercial |
$8.95
|
| Rate for Payer: United Healthcare All Payer |
$8.20
|
|
|
BETOPTIC (BETAXOLOL)0.5% O 5ML
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 61314024501
|
| Hospital Charge Code |
25000333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Anthem Medicaid |
$0.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.23
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cigna Commercial |
$2.37
|
| Rate for Payer: First Health Commercial |
$2.72
|
| Rate for Payer: Humana Commercial |
$2.43
|
| Rate for Payer: Humana KY Medicaid |
$0.98
|
| Rate for Payer: Kentucky WC Medicaid |
$0.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.52
|
| Rate for Payer: Ohio Health Group HMO |
$2.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.97
|
| Rate for Payer: PHCS Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Payer |
$2.52
|
|
|
BETOPTIC (BETAXOLOL)0.5% O 5ML
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 61314024501
|
| Hospital Charge Code |
25000333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.23
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cigna Commercial |
$2.37
|
| Rate for Payer: First Health Commercial |
$2.72
|
| Rate for Payer: Humana Commercial |
$2.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.52
|
| Rate for Payer: Ohio Health Group HMO |
$2.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.97
|
| Rate for Payer: PHCS Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Payer |
$2.52
|
|
|
BETOPTIC (BETAXOLOL) OPHT 10ML
|
Facility
|
IP
|
$4.71
|
|
|
Service Code
|
NDC 10135062301
|
| Hospital Charge Code |
25003805
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna Commercial |
$3.91
|
| Rate for Payer: First Health Commercial |
$4.47
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.25
|
| Rate for Payer: PHCS Commercial |
$4.52
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
BETOPTIC (BETAXOLOL) OPHT 10ML
|
Facility
|
OP
|
$4.71
|
|
|
Service Code
|
NDC 10135062301
|
| Hospital Charge Code |
25003805
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Anthem Medicaid |
$1.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna Commercial |
$3.91
|
| Rate for Payer: First Health Commercial |
$4.47
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Humana KY Medicaid |
$1.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.25
|
| Rate for Payer: PHCS Commercial |
$4.52
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
BETOPTIC S(BETAXOLOL) OPHT 5ML
|
Facility
|
IP
|
$5.05
|
|
|
Service Code
|
NDC 78072910
|
| Hospital Charge Code |
25000334
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.94
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.19
|
| Rate for Payer: First Health Commercial |
$4.80
|
| Rate for Payer: Humana Commercial |
$4.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| Rate for Payer: PHCS Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
BETOPTIC S(BETAXOLOL) OPHT 5ML
|
Facility
|
OP
|
$5.05
|
|
|
Service Code
|
NDC 78072910
|
| Hospital Charge Code |
25000334
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Anthem Medicaid |
$1.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.94
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.19
|
| Rate for Payer: First Health Commercial |
$4.80
|
| Rate for Payer: Humana Commercial |
$4.29
|
| Rate for Payer: Humana KY Medicaid |
$1.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| Rate for Payer: PHCS Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
BEYFORTUS100MG/MLSDV
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
77000095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.10 |
| Max. Negotiated Rate |
$1,014.72 |
| Rate for Payer: Aetna Commercial |
$813.89
|
| Rate for Payer: Anthem Medicaid |
$363.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$824.46
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cigna Commercial |
$877.31
|
| Rate for Payer: First Health Commercial |
$1,004.15
|
| Rate for Payer: Humana Commercial |
$898.45
|
| Rate for Payer: Humana KY Medicaid |
$363.50
|
| Rate for Payer: Kentucky WC Medicaid |
$367.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$866.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$780.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$370.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$930.16
|
| Rate for Payer: Ohio Health Group HMO |
$792.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$919.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$729.33
|
| Rate for Payer: PHCS Commercial |
$1,014.72
|
| Rate for Payer: United Healthcare All Payer |
$930.16
|
|
|
BEYFORTUS100MG/MLSDV
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
770T0095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.10 |
| Max. Negotiated Rate |
$1,014.72 |
| Rate for Payer: Aetna Commercial |
$813.89
|
| Rate for Payer: Anthem Medicaid |
$363.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$824.46
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cigna Commercial |
$877.31
|
| Rate for Payer: First Health Commercial |
$1,004.15
|
| Rate for Payer: Humana Commercial |
$898.45
|
| Rate for Payer: Humana KY Medicaid |
$363.50
|
| Rate for Payer: Kentucky WC Medicaid |
$367.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$866.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$780.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$370.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$930.16
|
| Rate for Payer: Ohio Health Group HMO |
$792.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$919.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$729.33
|
| Rate for Payer: PHCS Commercial |
$1,014.72
|
| Rate for Payer: United Healthcare All Payer |
$930.16
|
|
|
BEYFORTUS100MG/MLSDV
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
770T0095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.10 |
| Max. Negotiated Rate |
$1,014.72 |
| Rate for Payer: Aetna Commercial |
$813.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$824.46
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cigna Commercial |
$877.31
|
| Rate for Payer: First Health Commercial |
$1,004.15
|
| Rate for Payer: Humana Commercial |
$898.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$866.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$780.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$930.16
|
| Rate for Payer: Ohio Health Group HMO |
$792.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$919.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$729.33
|
| Rate for Payer: PHCS Commercial |
$1,014.72
|
| Rate for Payer: United Healthcare All Payer |
$930.16
|
|
|
BEYFORTUS100MG/MLSDV
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
77000095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.10 |
| Max. Negotiated Rate |
$1,014.72 |
| Rate for Payer: Aetna Commercial |
$813.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$824.46
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cigna Commercial |
$877.31
|
| Rate for Payer: First Health Commercial |
$1,004.15
|
| Rate for Payer: Humana Commercial |
$898.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$866.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$780.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$930.16
|
| Rate for Payer: Ohio Health Group HMO |
$792.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$919.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$729.33
|
| Rate for Payer: PHCS Commercial |
$1,014.72
|
| Rate for Payer: United Healthcare All Payer |
$930.16
|
|
|
BEYFORTUS100MG/MLSDV
|
Professional
|
Both
|
$1,057.00
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
77000095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$369.95 |
| Max. Negotiated Rate |
$739.90 |
| Rate for Payer: Anthem Medicaid |
$485.10
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Humana Medicaid |
$485.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$494.80
|
| Rate for Payer: Molina Healthcare Passport |
$485.10
|
| Rate for Payer: Multiplan PHCS |
$634.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$739.90
|
| Rate for Payer: UHCCP Medicaid |
$369.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$489.95
|
|
|
BEYFORTUS50MG/0.5MLSDV
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
770T0096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.10 |
| Max. Negotiated Rate |
$1,014.72 |
| Rate for Payer: Aetna Commercial |
$813.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$824.46
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cigna Commercial |
$877.31
|
| Rate for Payer: First Health Commercial |
$1,004.15
|
| Rate for Payer: Humana Commercial |
$898.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$866.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$780.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$930.16
|
| Rate for Payer: Ohio Health Group HMO |
$792.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$919.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$729.33
|
| Rate for Payer: PHCS Commercial |
$1,014.72
|
| Rate for Payer: United Healthcare All Payer |
$930.16
|
|
