|
BICILLIN LA 100K (0.6MMU)
|
Professional
|
Both
|
$93.38
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$56.03 |
| Rate for Payer: Aetna Commercial |
$20.45
|
| Rate for Payer: Ambetter Exchange |
$29.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.16
|
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.30
|
| Rate for Payer: Multiplan PHCS |
$56.03
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.09
|
| Rate for Payer: UHCCP Medicaid |
$32.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.30
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Facility
|
OP
|
$93.38
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600014
|
|
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
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Facility
|
IP
|
$560.30
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
25001892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.09 |
| Max. Negotiated Rate |
$537.89 |
| Rate for Payer: Aetna Commercial |
$431.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.03
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cigna Commercial |
$465.05
|
| Rate for Payer: First Health Commercial |
$532.28
|
| Rate for Payer: Humana Commercial |
$476.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.06
|
| Rate for Payer: Ohio Health Group HMO |
$420.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.61
|
| Rate for Payer: PHCS Commercial |
$537.89
|
| Rate for Payer: United Healthcare All Payer |
$493.06
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Facility
|
IP
|
$93.38
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
636T0014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.01 |
| Max. Negotiated Rate |
$89.64 |
| Rate for Payer: Aetna Commercial |
$71.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.84
|
| 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: 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 |
$28.01
|
| 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
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Facility
|
IP
|
$93.38
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.01 |
| Max. Negotiated Rate |
$89.64 |
| Rate for Payer: Aetna Commercial |
$71.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.84
|
| 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: 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 |
$28.01
|
| 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
|
|
|
BICILLIN LA 100K (0.6MMU)
|
Facility
|
OP
|
$560.30
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
25001892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$537.89 |
| Rate for Payer: Aetna Commercial |
$431.43
|
| Rate for Payer: Anthem Medicaid |
$192.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.55
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cash Price |
$280.15
|
| Rate for Payer: Cigna Commercial |
$465.05
|
| Rate for Payer: First Health Commercial |
$532.28
|
| Rate for Payer: Humana Commercial |
$476.25
|
| Rate for Payer: Humana KY Medicaid |
$192.69
|
| Rate for Payer: Humana Medicare Advantage |
$29.30
|
| Rate for Payer: Kentucky WC Medicaid |
$194.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.06
|
| Rate for Payer: Ohio Health Group HMO |
$420.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.61
|
| Rate for Payer: PHCS Commercial |
$537.89
|
| Rate for Payer: United Healthcare All Payer |
$493.06
|
|
|
BICILLIN LA 100K (1.2MMU)
|
Facility
|
IP
|
$657.14
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
25001893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$197.14 |
| Max. Negotiated Rate |
$630.85 |
| Rate for Payer: Aetna Commercial |
$506.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$512.57
|
| Rate for Payer: Cash Price |
$328.57
|
| Rate for Payer: Cigna Commercial |
$545.43
|
| Rate for Payer: First Health Commercial |
$624.28
|
| Rate for Payer: Humana Commercial |
$558.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$538.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$484.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$578.28
|
| Rate for Payer: Ohio Health Group HMO |
$492.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$525.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$453.43
|
| Rate for Payer: PHCS Commercial |
$630.85
|
| Rate for Payer: United Healthcare All Payer |
$578.28
|
|
|
BICILLIN LA 100K (1.2MMU)
|
Facility
|
OP
|
$657.14
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
25001893
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$630.85 |
| Rate for Payer: Aetna Commercial |
$506.00
|
| Rate for Payer: Anthem Medicaid |
$225.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$512.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.55
|
| Rate for Payer: Cash Price |
$328.57
|
| Rate for Payer: Cash Price |
$328.57
|
| Rate for Payer: Cigna Commercial |
$545.43
|
| Rate for Payer: First Health Commercial |
$624.28
|
| Rate for Payer: Humana Commercial |
$558.57
|
| Rate for Payer: Humana KY Medicaid |
$225.99
|
| Rate for Payer: Humana Medicare Advantage |
$29.30
|
| Rate for Payer: Kentucky WC Medicaid |
$228.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$538.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$484.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$230.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$578.28
|
| Rate for Payer: Ohio Health Group HMO |
$492.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$525.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$453.43
|
| Rate for Payer: PHCS Commercial |
$630.85
|
| Rate for Payer: United Healthcare All Payer |
$578.28
|
|
|
BICILLIN LA 100K (1.2MMU)
|
Facility
|
IP
|
$54.76
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
636T0015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$52.57 |
| Rate for Payer: Aetna Commercial |
$42.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.71
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Cigna Commercial |
$45.45
|
| Rate for Payer: First Health Commercial |
$52.02
|
| Rate for Payer: Humana Commercial |
$46.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.19
|
| Rate for Payer: Ohio Health Group HMO |
$41.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.78
|
| Rate for Payer: PHCS Commercial |
$52.57
|
| Rate for Payer: United Healthcare All Payer |
$48.19
|
|
|
BICILLIN LA 100K (1.2MMU)
|
Facility
|
OP
|
$54.76
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
636T0015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$52.57 |
| Rate for Payer: Aetna Commercial |
$42.17
|
| Rate for Payer: Anthem Medicaid |
$18.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.55
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Cigna Commercial |
$45.45
|
| Rate for Payer: First Health Commercial |
$52.02
|
| Rate for Payer: Humana Commercial |
$46.55
|
| Rate for Payer: Humana KY Medicaid |
$18.83
|
| Rate for Payer: Humana Medicare Advantage |
$29.30
|
| Rate for Payer: Kentucky WC Medicaid |
$19.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.19
|
| Rate for Payer: Ohio Health Group HMO |
$41.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.78
|
| Rate for Payer: PHCS Commercial |
$52.57
|
| Rate for Payer: United Healthcare All Payer |
$48.19
|
|
|
BICILLIN LA 100K (1.2MMU)
|
Facility
|
IP
|
$54.76
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$52.57 |
| Rate for Payer: Aetna Commercial |
$42.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.71
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Cigna Commercial |
$45.45
|
| Rate for Payer: First Health Commercial |
$52.02
|
| Rate for Payer: Humana Commercial |
$46.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.19
|
| Rate for Payer: Ohio Health Group HMO |
$41.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.78
|
| Rate for Payer: PHCS Commercial |
$52.57
|
| Rate for Payer: United Healthcare All Payer |
$48.19
|
|
|
BICILLIN LA 100K (1.2MMU)
|
Professional
|
Both
|
$54.76
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$38.09 |
| Rate for Payer: Aetna Commercial |
$20.45
|
| Rate for Payer: Ambetter Exchange |
$29.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.16
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.30
|
| Rate for Payer: Multiplan PHCS |
$32.86
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.09
|
| Rate for Payer: UHCCP Medicaid |
$19.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.30
|
|
|
BICILLIN LA 100K (1.2MMU)
|
Facility
|
OP
|
$54.76
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$52.57 |
| Rate for Payer: Aetna Commercial |
$42.17
|
| Rate for Payer: Anthem Medicaid |
$18.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.55
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Cigna Commercial |
$45.45
|
| Rate for Payer: First Health Commercial |
$52.02
|
| Rate for Payer: Humana Commercial |
$46.55
|
| Rate for Payer: Humana KY Medicaid |
$18.83
|
| Rate for Payer: Humana Medicare Advantage |
$29.30
|
| Rate for Payer: Kentucky WC Medicaid |
$19.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.19
|
| Rate for Payer: Ohio Health Group HMO |
$41.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.78
|
| Rate for Payer: PHCS Commercial |
$52.57
|
| Rate for Payer: United Healthcare All Payer |
$48.19
|
|
|
BICILLIN LA 100K (2.4MMU)
|
Facility
|
IP
|
$43.73
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
636T0013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$41.98 |
| Rate for Payer: Aetna Commercial |
$33.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.11
|
| Rate for Payer: Cash Price |
$21.86
|
| Rate for Payer: Cigna Commercial |
$36.30
|
| Rate for Payer: First Health Commercial |
$41.54
|
| Rate for Payer: Humana Commercial |
$37.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.48
|
| Rate for Payer: Ohio Health Group HMO |
$32.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.17
|
| Rate for Payer: PHCS Commercial |
$41.98
|
| Rate for Payer: United Healthcare All Payer |
$38.48
|
|
|
BICILLIN LA 100K (2.4MMU)
|
Professional
|
Both
|
$43.73
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$38.09 |
| Rate for Payer: Aetna Commercial |
$20.45
|
| Rate for Payer: Ambetter Exchange |
$29.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.16
|
| Rate for Payer: Cash Price |
$21.86
|
| Rate for Payer: Cash Price |
$21.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.30
|
| Rate for Payer: Multiplan PHCS |
$26.24
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.09
|
| Rate for Payer: UHCCP Medicaid |
$15.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.30
|
|
|
BICILLIN LA 100K (2.4MMU)
|
Facility
|
IP
|
$43.73
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$41.98 |
| Rate for Payer: Aetna Commercial |
$33.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.11
|
| Rate for Payer: Cash Price |
$21.86
|
| Rate for Payer: Cigna Commercial |
$36.30
|
| Rate for Payer: First Health Commercial |
$41.54
|
| Rate for Payer: Humana Commercial |
$37.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.48
|
| Rate for Payer: Ohio Health Group HMO |
$32.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.17
|
| Rate for Payer: PHCS Commercial |
$41.98
|
| Rate for Payer: United Healthcare All Payer |
$38.48
|
|
|
BICILLIN LA 100K (2.4MMU)
|
Facility
|
IP
|
$1,049.55
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
25001891
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$314.87 |
| Max. Negotiated Rate |
$1,007.57 |
| Rate for Payer: Aetna Commercial |
$808.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$818.65
|
| Rate for Payer: Cash Price |
$524.78
|
| Rate for Payer: Cigna Commercial |
$871.13
|
| Rate for Payer: First Health Commercial |
$997.07
|
| Rate for Payer: Humana Commercial |
$892.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$860.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$923.60
|
| Rate for Payer: Ohio Health Group HMO |
$787.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$839.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.19
|
| Rate for Payer: PHCS Commercial |
$1,007.57
|
| Rate for Payer: United Healthcare All Payer |
$923.60
|
|
|
BICILLIN LA 100K (2.4MMU)
|
Facility
|
OP
|
$1,049.55
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
25001891
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$1,007.57 |
| Rate for Payer: Aetna Commercial |
$808.15
|
| Rate for Payer: Anthem Medicaid |
$360.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$818.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.55
|
| Rate for Payer: Cash Price |
$524.78
|
| Rate for Payer: Cash Price |
$524.78
|
| Rate for Payer: Cigna Commercial |
$871.13
|
| Rate for Payer: First Health Commercial |
$997.07
|
| Rate for Payer: Humana Commercial |
$892.12
|
| Rate for Payer: Humana KY Medicaid |
$360.94
|
| Rate for Payer: Humana Medicare Advantage |
$29.30
|
| Rate for Payer: Kentucky WC Medicaid |
$364.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$860.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$368.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$923.60
|
| Rate for Payer: Ohio Health Group HMO |
$787.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$839.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.19
|
| Rate for Payer: PHCS Commercial |
$1,007.57
|
| Rate for Payer: United Healthcare All Payer |
$923.60
|
|
|
BICILLIN LA 100K (2.4MMU)
|
Facility
|
OP
|
$43.73
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
636T0013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$41.98 |
| Rate for Payer: Aetna Commercial |
$33.67
|
| Rate for Payer: Anthem Medicaid |
$15.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.55
|
| Rate for Payer: Cash Price |
$21.86
|
| Rate for Payer: Cash Price |
$21.86
|
| Rate for Payer: Cigna Commercial |
$36.30
|
| Rate for Payer: First Health Commercial |
$41.54
|
| Rate for Payer: Humana Commercial |
$37.17
|
| Rate for Payer: Humana KY Medicaid |
$15.04
|
| Rate for Payer: Humana Medicare Advantage |
$29.30
|
| Rate for Payer: Kentucky WC Medicaid |
$15.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.48
|
| Rate for Payer: Ohio Health Group HMO |
$32.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.17
|
| Rate for Payer: PHCS Commercial |
$41.98
|
| Rate for Payer: United Healthcare All Payer |
$38.48
|
|
|
BICILLIN LA 100K (2.4MMU)
|
Facility
|
OP
|
$43.73
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$41.98 |
| Rate for Payer: Aetna Commercial |
$33.67
|
| Rate for Payer: Anthem Medicaid |
$15.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.55
|
| Rate for Payer: Cash Price |
$21.86
|
| Rate for Payer: Cash Price |
$21.86
|
| Rate for Payer: Cigna Commercial |
$36.30
|
| Rate for Payer: First Health Commercial |
$41.54
|
| Rate for Payer: Humana Commercial |
$37.17
|
| Rate for Payer: Humana KY Medicaid |
$15.04
|
| Rate for Payer: Humana Medicare Advantage |
$29.30
|
| Rate for Payer: Kentucky WC Medicaid |
$15.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.48
|
| Rate for Payer: Ohio Health Group HMO |
$32.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.17
|
| Rate for Payer: PHCS Commercial |
$41.98
|
| Rate for Payer: United Healthcare All Payer |
$38.48
|
|
|
BICITRA SF(CITRIC AC/NA C 30ML
|
Facility
|
OP
|
$5.09
|
|
|
Service Code
|
NDC 121059516
|
| Hospital Charge Code |
25000336
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$4.89 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Anthem Medicaid |
$1.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.97
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cigna Commercial |
$4.22
|
| Rate for Payer: First Health Commercial |
$4.84
|
| Rate for Payer: Humana Commercial |
$4.33
|
| Rate for Payer: Humana KY Medicaid |
$1.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.48
|
| Rate for Payer: Ohio Health Group HMO |
$3.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.51
|
| Rate for Payer: PHCS Commercial |
$4.89
|
| Rate for Payer: United Healthcare All Payer |
$4.48
|
|
|
BICITRA SF(CITRIC AC/NA C 30ML
|
Facility
|
IP
|
$5.09
|
|
|
Service Code
|
NDC 121059516
|
| Hospital Charge Code |
25000336
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$4.89 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.97
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cigna Commercial |
$4.22
|
| Rate for Payer: First Health Commercial |
$4.84
|
| Rate for Payer: Humana Commercial |
$4.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.48
|
| Rate for Payer: Ohio Health Group HMO |
$3.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.51
|
| Rate for Payer: PHCS Commercial |
$4.89
|
| Rate for Payer: United Healthcare All Payer |
$4.48
|
|
|
BICNU 100MG VIAL
|
Facility
|
OP
|
$2,943.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
25002581
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.64 |
| Max. Negotiated Rate |
$2,825.28 |
| Rate for Payer: Aetna Commercial |
$2,266.11
|
| Rate for Payer: Anthem Medicaid |
$1,012.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,295.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$243.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$234.41
|
| Rate for Payer: Cash Price |
$1,471.50
|
| Rate for Payer: Cash Price |
$1,471.50
|
| Rate for Payer: Cigna Commercial |
$2,442.69
|
| Rate for Payer: First Health Commercial |
$2,795.85
|
| Rate for Payer: Humana Commercial |
$2,501.55
|
| Rate for Payer: Humana KY Medicaid |
$1,012.10
|
| Rate for Payer: Humana Medicare Advantage |
$173.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,022.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,413.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,171.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,032.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,589.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,207.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,354.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,560.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.67
|
| Rate for Payer: PHCS Commercial |
$2,825.28
|
| Rate for Payer: United Healthcare All Payer |
$2,589.84
|
|
|
BICNU 100MG VIAL
|
Facility
|
IP
|
$2,943.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
25002581
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$882.90 |
| Max. Negotiated Rate |
$2,825.28 |
| Rate for Payer: Aetna Commercial |
$2,266.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,295.54
|
| Rate for Payer: Cash Price |
$1,471.50
|
| Rate for Payer: Cigna Commercial |
$2,442.69
|
| Rate for Payer: First Health Commercial |
$2,795.85
|
| Rate for Payer: Humana Commercial |
$2,501.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,413.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,171.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,589.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,207.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,354.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,560.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,030.67
|
| Rate for Payer: PHCS Commercial |
$2,825.28
|
| Rate for Payer: United Healthcare All Payer |
$2,589.84
|
|
|
BICORTICAL TF SHAFT 3.5MM
|
Facility
|
IP
|
$3,087.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.25 |
| Max. Negotiated Rate |
$2,964.00 |
| Rate for Payer: Aetna Commercial |
$2,377.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,408.25
|
| Rate for Payer: Cash Price |
$1,543.75
|
| Rate for Payer: Cigna Commercial |
$2,562.62
|
| Rate for Payer: First Health Commercial |
$2,933.12
|
| Rate for Payer: Humana Commercial |
$2,624.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,531.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,278.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,717.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,315.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,686.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,130.38
|
| Rate for Payer: PHCS Commercial |
$2,964.00
|
| Rate for Payer: United Healthcare All Payer |
$2,717.00
|
|
