|
BHR ACTBNLR CUP W IMPCTR 52MM
|
Facility
|
IP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR ACTBNLR CUP W IMPCTR 52MM
|
Facility
|
OP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem Medicaid |
$7,310.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Humana KY Medicaid |
$7,310.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,384.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,456.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR FEMORAL HEAD 44 MM
|
Facility
|
OP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem Medicaid |
$8,496.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Humana KY Medicaid |
$8,496.48
|
| Rate for Payer: Kentucky WC Medicaid |
$8,582.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,666.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
BHR FEMORAL HEAD 44 MM
|
Facility
|
IP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
BHR GUIDE PINS SHORT
|
Facility
|
IP
|
$555.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.64 |
| Max. Negotiated Rate |
$533.26 |
| Rate for Payer: Aetna Commercial |
$427.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$433.27
|
| Rate for Payer: Cash Price |
$277.74
|
| Rate for Payer: Cigna Commercial |
$461.05
|
| Rate for Payer: First Health Commercial |
$527.71
|
| Rate for Payer: Humana Commercial |
$472.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$455.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$409.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$488.82
|
| Rate for Payer: Ohio Health Group HMO |
$416.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$444.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$383.28
|
| Rate for Payer: PHCS Commercial |
$533.26
|
| Rate for Payer: United Healthcare All Payer |
$488.82
|
|
|
BHR GUIDE PINS SHORT
|
Facility
|
OP
|
$555.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.64 |
| Max. Negotiated Rate |
$533.26 |
| Rate for Payer: Aetna Commercial |
$427.72
|
| Rate for Payer: Anthem Medicaid |
$191.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$433.27
|
| Rate for Payer: Cash Price |
$277.74
|
| Rate for Payer: Cigna Commercial |
$461.05
|
| Rate for Payer: First Health Commercial |
$527.71
|
| Rate for Payer: Humana Commercial |
$472.16
|
| Rate for Payer: Humana KY Medicaid |
$191.03
|
| Rate for Payer: Kentucky WC Medicaid |
$192.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$455.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$409.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$488.82
|
| Rate for Payer: Ohio Health Group HMO |
$416.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$444.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$383.28
|
| Rate for Payer: PHCS Commercial |
$533.26
|
| Rate for Payer: United Healthcare All Payer |
$488.82
|
|
|
BIAXIN (CLARITHROMY 500MG/1TAB
|
Facility
|
IP
|
$10.24
|
|
|
Service Code
|
NDC 50268017913
|
| Hospital Charge Code |
25002893
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.99
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.73
|
| Rate for Payer: Humana Commercial |
$8.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.01
|
| Rate for Payer: Ohio Health Group HMO |
$7.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.07
|
| Rate for Payer: PHCS Commercial |
$9.83
|
| Rate for Payer: United Healthcare All Payer |
$9.01
|
|
|
BIAXIN (CLARITHROMY 500MG/1TAB
|
Facility
|
OP
|
$10.24
|
|
|
Service Code
|
NDC 50268017913
|
| Hospital Charge Code |
25002893
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$9.83 |
| Rate for Payer: Aetna Commercial |
$7.88
|
| Rate for Payer: Anthem Medicaid |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.99
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: First Health Commercial |
$9.73
|
| Rate for Payer: Humana Commercial |
$8.70
|
| Rate for Payer: Humana KY Medicaid |
$3.52
|
| Rate for Payer: Kentucky WC Medicaid |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.01
|
| Rate for Payer: Ohio Health Group HMO |
$7.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.07
|
| Rate for Payer: PHCS Commercial |
$9.83
|
| Rate for Payer: United Healthcare All Payer |
$9.01
|
|
|
BI BR IMPLANT REM-INTACT OFC
|
Professional
|
Both
|
$2,000.00
|
|
| Hospital Charge Code |
22200718
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
|
|
BI BR IMPLANT REM-RUPT OFC
|
Professional
|
Both
|
$2,000.00
|
|
| Hospital Charge Code |
22200719
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Professional
|
Both
|
$52.41
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: Aetna Commercial |
$16.13
|
| Rate for Payer: Ambetter Exchange |
$17.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$17.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$17.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.84
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$17.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.37
|
| Rate for Payer: Multiplan PHCS |
$31.45
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$22.58
|
| Rate for Payer: UHCCP Medicaid |
$18.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.37
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Facility
|
OP
|
$52.41
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$50.31 |
| Rate for Payer: Aetna Commercial |
$40.36
|
| Rate for Payer: Anthem Medicaid |
$18.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.45
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cigna Commercial |
$43.50
|
| Rate for Payer: First Health Commercial |
$49.79
|
| Rate for Payer: Humana Commercial |
$44.55
|
| Rate for Payer: Humana KY Medicaid |
$18.02
|
| Rate for Payer: Humana Medicare Advantage |
$17.37
|
| Rate for Payer: Kentucky WC Medicaid |
$18.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.12
|
| Rate for Payer: Ohio Health Group HMO |
$39.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.16
|
| Rate for Payer: PHCS Commercial |
$50.31
|
| Rate for Payer: United Healthcare All Payer |
$46.12
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Facility
|
OP
|
$52.41
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
636T0012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$50.31 |
| Rate for Payer: Aetna Commercial |
$40.36
|
| Rate for Payer: Anthem Medicaid |
$18.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.45
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cigna Commercial |
$43.50
|
| Rate for Payer: First Health Commercial |
$49.79
|
| Rate for Payer: Humana Commercial |
$44.55
|
| Rate for Payer: Humana KY Medicaid |
$18.02
|
| Rate for Payer: Humana Medicare Advantage |
$17.37
|
| Rate for Payer: Kentucky WC Medicaid |
$18.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.12
|
| Rate for Payer: Ohio Health Group HMO |
$39.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.16
|
| Rate for Payer: PHCS Commercial |
$50.31
|
| Rate for Payer: United Healthcare All Payer |
$46.12
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Facility
|
IP
|
$52.41
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
636T0012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$50.31 |
| Rate for Payer: Aetna Commercial |
$40.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.88
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cigna Commercial |
$43.50
|
| Rate for Payer: First Health Commercial |
$49.79
|
| Rate for Payer: Humana Commercial |
$44.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.12
|
| Rate for Payer: Ohio Health Group HMO |
$39.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.16
|
| Rate for Payer: PHCS Commercial |
$50.31
|
| Rate for Payer: United Healthcare All Payer |
$46.12
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Facility
|
IP
|
$52.41
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$50.31 |
| Rate for Payer: Aetna Commercial |
$40.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.88
|
| Rate for Payer: Cash Price |
$26.20
|
| Rate for Payer: Cigna Commercial |
$43.50
|
| Rate for Payer: First Health Commercial |
$49.79
|
| Rate for Payer: Humana Commercial |
$44.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.12
|
| Rate for Payer: Ohio Health Group HMO |
$39.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.16
|
| Rate for Payer: PHCS Commercial |
$50.31
|
| Rate for Payer: United Healthcare All Payer |
$46.12
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Facility
|
OP
|
$628.92
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
25001890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$603.76 |
| Rate for Payer: Aetna Commercial |
$484.27
|
| Rate for Payer: Anthem Medicaid |
$216.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$490.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.45
|
| Rate for Payer: Cash Price |
$314.46
|
| Rate for Payer: Cash Price |
$314.46
|
| Rate for Payer: Cigna Commercial |
$522.00
|
| Rate for Payer: First Health Commercial |
$597.47
|
| Rate for Payer: Humana Commercial |
$534.58
|
| Rate for Payer: Humana KY Medicaid |
$216.29
|
| Rate for Payer: Humana Medicare Advantage |
$17.37
|
| Rate for Payer: Kentucky WC Medicaid |
$218.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$515.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$220.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$553.45
|
| Rate for Payer: Ohio Health Group HMO |
$471.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$433.95
|
| Rate for Payer: PHCS Commercial |
$603.76
|
| Rate for Payer: United Healthcare All Payer |
$553.45
|
|
|
BICILLIN CR 100KU (1.2 MMU)
|
Facility
|
IP
|
$628.92
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
25001890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.68 |
| Max. Negotiated Rate |
$603.76 |
| Rate for Payer: Aetna Commercial |
$484.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$490.56
|
| Rate for Payer: Cash Price |
$314.46
|
| Rate for Payer: Cigna Commercial |
$522.00
|
| Rate for Payer: First Health Commercial |
$597.47
|
| Rate for Payer: Humana Commercial |
$534.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$515.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$553.45
|
| Rate for Payer: Ohio Health Group HMO |
$471.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$433.95
|
| Rate for Payer: PHCS Commercial |
$603.76
|
| Rate for Payer: United Healthcare All Payer |
$553.45
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Facility
|
IP
|
$50.89
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
636T0113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.27 |
| Max. Negotiated Rate |
$48.85 |
| Rate for Payer: Aetna Commercial |
$39.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.69
|
| Rate for Payer: Cash Price |
$25.44
|
| Rate for Payer: Cigna Commercial |
$42.24
|
| Rate for Payer: First Health Commercial |
$48.35
|
| Rate for Payer: Humana Commercial |
$43.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.78
|
| Rate for Payer: Ohio Health Group HMO |
$38.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.11
|
| Rate for Payer: PHCS Commercial |
$48.85
|
| Rate for Payer: United Healthcare All Payer |
$44.78
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Facility
|
OP
|
$610.66
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
25003926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$586.23 |
| Rate for Payer: Aetna Commercial |
$470.21
|
| Rate for Payer: Anthem Medicaid |
$210.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.45
|
| Rate for Payer: Cash Price |
$305.33
|
| Rate for Payer: Cash Price |
$305.33
|
| Rate for Payer: Cigna Commercial |
$506.85
|
| Rate for Payer: First Health Commercial |
$580.13
|
| Rate for Payer: Humana Commercial |
$519.06
|
| Rate for Payer: Humana KY Medicaid |
$210.01
|
| Rate for Payer: Humana Medicare Advantage |
$17.37
|
| Rate for Payer: Kentucky WC Medicaid |
$212.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$500.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$214.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$537.38
|
| Rate for Payer: Ohio Health Group HMO |
$458.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$421.36
|
| Rate for Payer: PHCS Commercial |
$586.23
|
| Rate for Payer: United Healthcare All Payer |
$537.38
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Facility
|
IP
|
$610.66
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
25003926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.20 |
| Max. Negotiated Rate |
$586.23 |
| Rate for Payer: Aetna Commercial |
$470.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.31
|
| Rate for Payer: Cash Price |
$305.33
|
| Rate for Payer: Cigna Commercial |
$506.85
|
| Rate for Payer: First Health Commercial |
$580.13
|
| Rate for Payer: Humana Commercial |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$500.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$537.38
|
| Rate for Payer: Ohio Health Group HMO |
$458.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$421.36
|
| Rate for Payer: PHCS Commercial |
$586.23
|
| Rate for Payer: United Healthcare All Payer |
$537.38
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Facility
|
OP
|
$50.89
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$48.85 |
| Rate for Payer: Aetna Commercial |
$39.19
|
| Rate for Payer: Anthem Medicaid |
$17.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.45
|
| Rate for Payer: Cash Price |
$25.44
|
| Rate for Payer: Cash Price |
$25.44
|
| Rate for Payer: Cigna Commercial |
$42.24
|
| Rate for Payer: First Health Commercial |
$48.35
|
| Rate for Payer: Humana Commercial |
$43.26
|
| Rate for Payer: Humana KY Medicaid |
$17.50
|
| Rate for Payer: Humana Medicare Advantage |
$17.37
|
| Rate for Payer: Kentucky WC Medicaid |
$17.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.78
|
| Rate for Payer: Ohio Health Group HMO |
$38.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.11
|
| Rate for Payer: PHCS Commercial |
$48.85
|
| Rate for Payer: United Healthcare All Payer |
$44.78
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Facility
|
OP
|
$50.89
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
636T0113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$48.85 |
| Rate for Payer: Aetna Commercial |
$39.19
|
| Rate for Payer: Anthem Medicaid |
$17.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.45
|
| Rate for Payer: Cash Price |
$25.44
|
| Rate for Payer: Cash Price |
$25.44
|
| Rate for Payer: Cigna Commercial |
$42.24
|
| Rate for Payer: First Health Commercial |
$48.35
|
| Rate for Payer: Humana Commercial |
$43.26
|
| Rate for Payer: Humana KY Medicaid |
$17.50
|
| Rate for Payer: Humana Medicare Advantage |
$17.37
|
| Rate for Payer: Kentucky WC Medicaid |
$17.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.78
|
| Rate for Payer: Ohio Health Group HMO |
$38.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.11
|
| Rate for Payer: PHCS Commercial |
$48.85
|
| Rate for Payer: United Healthcare All Payer |
$44.78
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Professional
|
Both
|
$50.89
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Aetna Commercial |
$16.13
|
| Rate for Payer: Ambetter Exchange |
$17.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$17.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$17.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.84
|
| Rate for Payer: Cash Price |
$25.44
|
| Rate for Payer: Cash Price |
$25.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$17.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.37
|
| Rate for Payer: Multiplan PHCS |
$30.53
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$22.58
|
| Rate for Payer: UHCCP Medicaid |
$17.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.37
|
|
|
BICILLIN CR 100KU (1.2MMU) PED
|
Facility
|
IP
|
$50.89
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.27 |
| Max. Negotiated Rate |
$48.85 |
| Rate for Payer: Aetna Commercial |
$39.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.69
|
| Rate for Payer: Cash Price |
$25.44
|
| Rate for Payer: Cigna Commercial |
$42.24
|
| Rate for Payer: First Health Commercial |
$48.35
|
| Rate for Payer: Humana Commercial |
$43.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.78
|
| Rate for Payer: Ohio Health Group HMO |
$38.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.11
|
| Rate for Payer: PHCS Commercial |
$48.85
|
| Rate for Payer: United Healthcare All Payer |
$44.78
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Facility
|
OP
|
$93.38
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
636T0014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$89.64 |
| Rate for Payer: Aetna Commercial |
$71.90
|
| Rate for Payer: Anthem Medicaid |
$32.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.55
|
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Cigna Commercial |
$77.51
|
| Rate for Payer: First Health Commercial |
$88.71
|
| Rate for Payer: Humana Commercial |
$79.37
|
| Rate for Payer: Humana KY Medicaid |
$32.11
|
| Rate for Payer: Humana Medicare Advantage |
$29.30
|
| Rate for Payer: Kentucky WC Medicaid |
$32.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.17
|
| Rate for Payer: Ohio Health Group HMO |
$70.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.43
|
| Rate for Payer: PHCS Commercial |
$89.64
|
| Rate for Payer: United Healthcare All Payer |
$82.17
|
|
