|
TORADOL 15MG (30MG/1ML VL)
|
Facility
|
OP
|
$38.88
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63600037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$37.32 |
| Rate for Payer: Aetna Commercial |
$29.94
|
| Rate for Payer: Anthem Medicaid |
$13.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cigna Commercial |
$32.27
|
| Rate for Payer: First Health Commercial |
$36.94
|
| Rate for Payer: Humana Commercial |
$33.05
|
| Rate for Payer: Humana KY Medicaid |
$13.37
|
| Rate for Payer: Humana Medicare Advantage |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$13.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.21
|
| Rate for Payer: Ohio Health Group HMO |
$29.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.83
|
| Rate for Payer: PHCS Commercial |
$37.32
|
| Rate for Payer: United Healthcare All Payer |
$34.21
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Facility
|
IP
|
$38.88
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63600037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$37.32 |
| Rate for Payer: Aetna Commercial |
$29.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.33
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cigna Commercial |
$32.27
|
| Rate for Payer: First Health Commercial |
$36.94
|
| Rate for Payer: Humana Commercial |
$33.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.21
|
| Rate for Payer: Ohio Health Group HMO |
$29.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.83
|
| Rate for Payer: PHCS Commercial |
$37.32
|
| Rate for Payer: United Healthcare All Payer |
$34.21
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Facility
|
IP
|
$77.75
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
25002198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$74.64 |
| Rate for Payer: Aetna Commercial |
$59.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.65
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cigna Commercial |
$64.53
|
| Rate for Payer: First Health Commercial |
$73.86
|
| Rate for Payer: Humana Commercial |
$66.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.42
|
| Rate for Payer: Ohio Health Group HMO |
$58.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.65
|
| Rate for Payer: PHCS Commercial |
$74.64
|
| Rate for Payer: United Healthcare All Payer |
$68.42
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Facility
|
OP
|
$77.75
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
25002198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$74.64 |
| Rate for Payer: Aetna Commercial |
$59.87
|
| Rate for Payer: Anthem Medicaid |
$26.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cigna Commercial |
$64.53
|
| Rate for Payer: First Health Commercial |
$73.86
|
| Rate for Payer: Humana Commercial |
$66.09
|
| Rate for Payer: Humana KY Medicaid |
$26.74
|
| Rate for Payer: Humana Medicare Advantage |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$27.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.42
|
| Rate for Payer: Ohio Health Group HMO |
$58.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.65
|
| Rate for Payer: PHCS Commercial |
$74.64
|
| Rate for Payer: United Healthcare All Payer |
$68.42
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Professional
|
Both
|
$37.38
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
25002198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna Commercial |
$0.66
|
| Rate for Payer: Ambetter Exchange |
$0.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.42
|
| Rate for Payer: Cash Price |
$18.69
|
| Rate for Payer: Cash Price |
$18.69
|
| Rate for Payer: Healthspan PPO |
$0.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.35
|
| Rate for Payer: Multiplan PHCS |
$22.43
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.46
|
| Rate for Payer: UHCCP Medicaid |
$13.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.35
|
|
|
TORADOL 15MG (30MG/1ML VL)
|
Professional
|
Both
|
$38.88
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63600037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$23.33 |
| Rate for Payer: Aetna Commercial |
$0.66
|
| Rate for Payer: Ambetter Exchange |
$0.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.42
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Healthspan PPO |
$0.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.35
|
| Rate for Payer: Multiplan PHCS |
$23.33
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.46
|
| Rate for Payer: UHCCP Medicaid |
$13.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.35
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Facility
|
IP
|
$19.44
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
636T0036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Aetna Commercial |
$14.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.16
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna Commercial |
$16.14
|
| Rate for Payer: First Health Commercial |
$18.47
|
| Rate for Payer: Humana Commercial |
$16.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.11
|
| Rate for Payer: Ohio Health Group HMO |
$14.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.41
|
| Rate for Payer: PHCS Commercial |
$18.66
|
| Rate for Payer: United Healthcare All Payer |
$17.11
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Facility
|
OP
|
$19.44
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
636T0036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Aetna Commercial |
$14.97
|
| Rate for Payer: Anthem Medicaid |
$6.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna Commercial |
$16.14
|
| Rate for Payer: First Health Commercial |
$18.47
|
| Rate for Payer: Humana Commercial |
$16.52
|
| Rate for Payer: Humana KY Medicaid |
$6.69
|
| Rate for Payer: Humana Medicare Advantage |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.11
|
| Rate for Payer: Ohio Health Group HMO |
$14.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.41
|
| Rate for Payer: PHCS Commercial |
$18.66
|
| Rate for Payer: United Healthcare All Payer |
$17.11
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Facility
|
OP
|
$77.24
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
25002197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$74.15 |
| Rate for Payer: Aetna Commercial |
$59.47
|
| Rate for Payer: Anthem Medicaid |
$26.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: First Health Commercial |
$73.38
|
| Rate for Payer: Humana Commercial |
$65.65
|
| Rate for Payer: Humana KY Medicaid |
$26.56
|
| Rate for Payer: Humana Medicare Advantage |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$26.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.97
|
| Rate for Payer: Ohio Health Group HMO |
$57.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.30
|
| Rate for Payer: PHCS Commercial |
$74.15
|
| Rate for Payer: United Healthcare All Payer |
$67.97
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Facility
|
IP
|
$77.24
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
25002197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$74.15 |
| Rate for Payer: Aetna Commercial |
$59.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.25
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: First Health Commercial |
$73.38
|
| Rate for Payer: Humana Commercial |
$65.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.97
|
| Rate for Payer: Ohio Health Group HMO |
$57.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.30
|
| Rate for Payer: PHCS Commercial |
$74.15
|
| Rate for Payer: United Healthcare All Payer |
$67.97
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Facility
|
OP
|
$19.44
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63600036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Aetna Commercial |
$14.97
|
| Rate for Payer: Anthem Medicaid |
$6.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna Commercial |
$16.14
|
| Rate for Payer: First Health Commercial |
$18.47
|
| Rate for Payer: Humana Commercial |
$16.52
|
| Rate for Payer: Humana KY Medicaid |
$6.69
|
| Rate for Payer: Humana Medicare Advantage |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.11
|
| Rate for Payer: Ohio Health Group HMO |
$14.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.41
|
| Rate for Payer: PHCS Commercial |
$18.66
|
| Rate for Payer: United Healthcare All Payer |
$17.11
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Facility
|
IP
|
$19.44
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63600036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Aetna Commercial |
$14.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.16
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cigna Commercial |
$16.14
|
| Rate for Payer: First Health Commercial |
$18.47
|
| Rate for Payer: Humana Commercial |
$16.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.11
|
| Rate for Payer: Ohio Health Group HMO |
$14.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.41
|
| Rate for Payer: PHCS Commercial |
$18.66
|
| Rate for Payer: United Healthcare All Payer |
$17.11
|
|
|
TORADOL (KETORALAC TR 60MG/2ML
|
Professional
|
Both
|
$19.44
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
63600036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Aetna Commercial |
$0.66
|
| Rate for Payer: Ambetter Exchange |
$0.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.42
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Healthspan PPO |
$0.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.35
|
| Rate for Payer: Multiplan PHCS |
$11.66
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.46
|
| Rate for Payer: UHCCP Medicaid |
$6.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.35
|
|
|
TORADOL(KETOROLAC TR 10MG/1TAB
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 35573045002
|
| Hospital Charge Code |
25001576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Anthem Medicaid |
$1.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.90
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.15
|
| Rate for Payer: First Health Commercial |
$4.75
|
| Rate for Payer: Humana Commercial |
$4.25
|
| Rate for Payer: Humana KY Medicaid |
$1.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.40
|
| Rate for Payer: Ohio Health Group HMO |
$3.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.45
|
| Rate for Payer: PHCS Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Payer |
$4.40
|
|
|
TORADOL(KETOROLAC TR 10MG/1TAB
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 35573045002
|
| Hospital Charge Code |
25001576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.90
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.15
|
| Rate for Payer: First Health Commercial |
$4.75
|
| Rate for Payer: Humana Commercial |
$4.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.40
|
| Rate for Payer: Ohio Health Group HMO |
$3.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.45
|
| Rate for Payer: PHCS Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Payer |
$4.40
|
|
|
TORISEL 1 MG (25MG VIAL)
|
Facility
|
IP
|
$32,705.23
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
25002682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,811.57 |
| Max. Negotiated Rate |
$31,397.02 |
| Rate for Payer: Aetna Commercial |
$25,183.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,510.08
|
| Rate for Payer: Cash Price |
$16,352.61
|
| Rate for Payer: Cigna Commercial |
$27,145.34
|
| Rate for Payer: First Health Commercial |
$31,069.97
|
| Rate for Payer: Humana Commercial |
$27,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,818.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,136.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,811.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,780.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,528.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,164.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,453.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,566.61
|
| Rate for Payer: PHCS Commercial |
$31,397.02
|
| Rate for Payer: United Healthcare All Payer |
$28,780.60
|
|
|
TORISEL 1 MG (25MG VIAL)
|
Facility
|
OP
|
$32,705.23
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
25002682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.29 |
| Max. Negotiated Rate |
$31,397.02 |
| Rate for Payer: Aetna Commercial |
$25,183.03
|
| Rate for Payer: Anthem Medicaid |
$11,247.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,510.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.59
|
| Rate for Payer: Cash Price |
$16,352.61
|
| Rate for Payer: Cash Price |
$16,352.61
|
| Rate for Payer: Cigna Commercial |
$27,145.34
|
| Rate for Payer: First Health Commercial |
$31,069.97
|
| Rate for Payer: Humana Commercial |
$27,799.45
|
| Rate for Payer: Humana KY Medicaid |
$11,247.33
|
| Rate for Payer: Humana Medicare Advantage |
$32.29
|
| Rate for Payer: Kentucky WC Medicaid |
$11,361.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,818.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,136.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,472.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,780.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,528.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,164.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,453.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,566.61
|
| Rate for Payer: PHCS Commercial |
$31,397.02
|
| Rate for Payer: United Healthcare All Payer |
$28,780.60
|
|
|
TORP SHEA 1MM SHAFT 7MM LENGTH
|
Facility
|
OP
|
$1,871.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.40 |
| Max. Negotiated Rate |
$1,796.48 |
| Rate for Payer: Aetna Commercial |
$1,440.92
|
| Rate for Payer: Anthem Medicaid |
$643.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,459.64
|
| Rate for Payer: Cash Price |
$935.66
|
| Rate for Payer: Cigna Commercial |
$1,553.20
|
| Rate for Payer: First Health Commercial |
$1,777.76
|
| Rate for Payer: Humana Commercial |
$1,590.63
|
| Rate for Payer: Humana KY Medicaid |
$643.55
|
| Rate for Payer: Kentucky WC Medicaid |
$650.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,534.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,646.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,403.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,497.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,628.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,291.22
|
| Rate for Payer: PHCS Commercial |
$1,796.48
|
| Rate for Payer: United Healthcare All Payer |
$1,646.77
|
|
|
TORP SHEA 1MM SHAFT 7MM LENGTH
|
Facility
|
IP
|
$1,871.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.40 |
| Max. Negotiated Rate |
$1,796.48 |
| Rate for Payer: Aetna Commercial |
$1,440.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,459.64
|
| Rate for Payer: Cash Price |
$935.66
|
| Rate for Payer: Cigna Commercial |
$1,553.20
|
| Rate for Payer: First Health Commercial |
$1,777.76
|
| Rate for Payer: Humana Commercial |
$1,590.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,534.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,646.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,403.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,497.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,628.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,291.22
|
| Rate for Payer: PHCS Commercial |
$1,796.48
|
| Rate for Payer: United Healthcare All Payer |
$1,646.77
|
|
|
TOTAL ABD COLECT WOANAST/ILEOS
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
HCPCS 45399
|
| Hospital Charge Code |
761P1904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,067.50 |
| Max. Negotiated Rate |
$2,135.00 |
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Multiplan PHCS |
$1,830.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,135.00
|
| Rate for Payer: UHCCP Medicaid |
$1,067.50
|
|
|
TOTAL ABD COLECT WOANAST/ILEOS
|
Facility
|
OP
|
$3,050.00
|
|
|
Service Code
|
HCPCS 45399
|
| Hospital Charge Code |
76101904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$842.40 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem Medicaid |
$1,048.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Humana KY Medicaid |
$1,048.89
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,059.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,069.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,653.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
TOTAL ABD COLECT WOANAST/ILEOS
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
HCPCS 45399
|
| Hospital Charge Code |
76101904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,067.50 |
| Max. Negotiated Rate |
$2,135.00 |
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Multiplan PHCS |
$1,830.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,135.00
|
| Rate for Payer: UHCCP Medicaid |
$1,067.50
|
|
|
TOTAL ABD COLECT WOANAST/ILEOS
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
HCPCS 45399
|
| Hospital Charge Code |
76101904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,653.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
TOTAL AB HYST
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 58200
|
| Hospital Charge Code |
76102213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem Medicaid |
$1,375.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Humana KY Medicaid |
$1,375.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
TOTAL AB HYST
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 58200
|
| Hospital Charge Code |
76102213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
