|
VALIUM (DIAZEPAM) 5MG/1TAB
|
Facility
|
IP
|
$60.05
|
|
|
Service Code
|
NDC 378034501
|
| Hospital Charge Code |
25002774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$57.65 |
| Rate for Payer: Aetna Commercial |
$46.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.84
|
| Rate for Payer: Cash Price |
$30.02
|
| Rate for Payer: Cigna Commercial |
$49.84
|
| Rate for Payer: First Health Commercial |
$57.05
|
| Rate for Payer: Humana Commercial |
$51.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.84
|
| Rate for Payer: Ohio Health Group HMO |
$45.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.62
|
| Rate for Payer: PHCS Commercial |
$57.65
|
| Rate for Payer: United Healthcare All Payer |
$52.84
|
|
|
VALIUM (DIAZEPAM) 5MG/1TAB
|
Facility
|
OP
|
$60.05
|
|
|
Service Code
|
NDC 378034501
|
| Hospital Charge Code |
25002774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$57.65 |
| Rate for Payer: Anthem Medicaid |
$20.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.84
|
| Rate for Payer: Cash Price |
$30.02
|
| Rate for Payer: Cigna Commercial |
$49.84
|
| Rate for Payer: First Health Commercial |
$57.05
|
| Rate for Payer: Humana Commercial |
$51.04
|
| Rate for Payer: Humana KY Medicaid |
$20.65
|
| Rate for Payer: Kentucky WC Medicaid |
$20.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.84
|
| Rate for Payer: Ohio Health Group HMO |
$45.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.62
|
| Rate for Payer: PHCS Commercial |
$57.65
|
| Rate for Payer: United Healthcare All Payer |
$52.84
|
| Rate for Payer: Aetna Commercial |
$46.24
|
|
|
VALPROIC ACID
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
30000026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem Medicaid |
$13.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.54
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Humana KY Medicaid |
$13.54
|
| Rate for Payer: Humana Medicare Advantage |
$13.54
|
| Rate for Payer: Kentucky WC Medicaid |
$13.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.14
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
VALPROIC ACID
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
30000026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.48
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.14
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
VAL SCREW TI 2.0 X 40MM
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
VAL SCREW TI 2.0 X 40MM
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem Medicaid |
$632.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Humana KY Medicaid |
$632.78
|
| Rate for Payer: Kentucky WC Medicaid |
$639.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
VALSTAR 200 MG [800MG PKG
|
Facility
|
IP
|
$12,449.22
|
|
|
Service Code
|
HCPCS J9357
|
| Hospital Charge Code |
25002688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,618.40 |
| Max. Negotiated Rate |
$11,951.25 |
| Rate for Payer: Aetna Commercial |
$9,585.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,710.39
|
| Rate for Payer: Cash Price |
$6,224.61
|
| Rate for Payer: Cigna Commercial |
$10,332.85
|
| Rate for Payer: First Health Commercial |
$11,826.76
|
| Rate for Payer: Humana Commercial |
$10,581.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,208.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,187.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,734.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,955.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,336.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,489.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,859.26
|
| Rate for Payer: PHCS Commercial |
$11,951.25
|
| Rate for Payer: United Healthcare All Payer |
$10,955.31
|
|
|
VALSTAR 200 MG [800MG PKG
|
Facility
|
OP
|
$12,449.22
|
|
|
Service Code
|
HCPCS J9357
|
| Hospital Charge Code |
25002688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,363.85 |
| Max. Negotiated Rate |
$11,951.25 |
| Rate for Payer: Aetna Commercial |
$9,585.90
|
| Rate for Payer: Anthem Medicaid |
$4,281.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,363.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,710.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,909.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,841.19
|
| Rate for Payer: Cash Price |
$6,224.61
|
| Rate for Payer: Cash Price |
$6,224.61
|
| Rate for Payer: Cigna Commercial |
$10,332.85
|
| Rate for Payer: First Health Commercial |
$11,826.76
|
| Rate for Payer: Humana Commercial |
$10,581.84
|
| Rate for Payer: Humana KY Medicaid |
$4,281.29
|
| Rate for Payer: Humana Medicare Advantage |
$1,363.85
|
| Rate for Payer: Kentucky WC Medicaid |
$4,324.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,208.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,187.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,367.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,955.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,336.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,489.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,859.26
|
| Rate for Payer: PHCS Commercial |
$11,951.25
|
| Rate for Payer: United Healthcare All Payer |
$10,955.31
|
|
|
VALTREX(VALACYCLOV 500MG/1CAP
|
Facility
|
OP
|
$5.01
|
|
|
Service Code
|
NDC 31722070430
|
| Hospital Charge Code |
25001647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Kentucky WC Medicaid |
$1.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.41
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Anthem Medicaid |
$1.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.91
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: First Health Commercial |
$4.76
|
| Rate for Payer: Humana Commercial |
$4.26
|
| Rate for Payer: Humana KY Medicaid |
$1.72
|
|
|
VALTREX(VALACYCLOV 500MG/1CAP
|
Facility
|
IP
|
$5.01
|
|
|
Service Code
|
NDC 31722070430
|
| Hospital Charge Code |
25001647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.91
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: First Health Commercial |
$4.76
|
| Rate for Payer: Humana Commercial |
$4.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.41
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
|
|
VALVULOPLASTY
|
Professional
|
Both
|
$5,600.00
|
|
|
Service Code
|
HCPCS 33464
|
| Hospital Charge Code |
76101293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,779.97 |
| Max. Negotiated Rate |
$5,600.00 |
| Rate for Payer: Aetna Commercial |
$4,025.17
|
| Rate for Payer: Anthem Medicaid |
$1,779.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,600.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$3,674.36
|
| Rate for Payer: Healthspan PPO |
$3,957.53
|
| Rate for Payer: Humana Medicaid |
$1,779.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,446.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,815.57
|
| Rate for Payer: Molina Healthcare Passport |
$1,779.97
|
| Rate for Payer: Multiplan PHCS |
$3,360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,920.00
|
| Rate for Payer: UHCCP Medicaid |
$1,960.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,797.77
|
|
|
VALVULOPLASTY
|
Facility
|
IP
|
$5,600.00
|
|
|
Service Code
|
HCPCS 33464
|
| Hospital Charge Code |
76101293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$728.00 |
| Max. Negotiated Rate |
$5,376.00 |
| Rate for Payer: Aetna Commercial |
$4,312.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$4,648.00
|
| Rate for Payer: First Health Commercial |
$5,320.00
|
| Rate for Payer: Humana Commercial |
$4,760.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,132.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,736.00
|
| Rate for Payer: PHCS Commercial |
$5,376.00
|
| Rate for Payer: United Healthcare All Payer |
$4,928.00
|
|
|
VALVULOPLASTY
|
Facility
|
OP
|
$5,600.00
|
|
|
Service Code
|
HCPCS 33464
|
| Hospital Charge Code |
76101293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$728.00 |
| Max. Negotiated Rate |
$5,376.00 |
| Rate for Payer: Aetna Commercial |
$4,312.00
|
| Rate for Payer: Anthem Medicaid |
$1,925.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$4,648.00
|
| Rate for Payer: First Health Commercial |
$5,320.00
|
| Rate for Payer: Humana Commercial |
$4,760.00
|
| Rate for Payer: Humana KY Medicaid |
$1,925.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,945.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,132.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,964.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,736.00
|
| Rate for Payer: PHCS Commercial |
$5,376.00
|
| Rate for Payer: United Healthcare All Payer |
$4,928.00
|
|
|
VALVULOPLASTY(P
|
Professional
|
Both
|
$5,600.00
|
|
|
Service Code
|
HCPCS 33464
|
| Hospital Charge Code |
761P1293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,779.97 |
| Max. Negotiated Rate |
$5,600.00 |
| Rate for Payer: Aetna Commercial |
$4,025.17
|
| Rate for Payer: Anthem Medicaid |
$1,779.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,600.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$3,674.36
|
| Rate for Payer: Healthspan PPO |
$3,957.53
|
| Rate for Payer: Humana Medicaid |
$1,779.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,446.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,815.57
|
| Rate for Payer: Molina Healthcare Passport |
$1,779.97
|
| Rate for Payer: Multiplan PHCS |
$3,360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,920.00
|
| Rate for Payer: UHCCP Medicaid |
$1,960.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,797.77
|
|
|
VALVULOPLASTY TRICUSPID
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS 33463
|
| Hospital Charge Code |
76101292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
VALVULOPLASTY TRICUSPID
|
Professional
|
Both
|
$5,350.00
|
|
|
Service Code
|
HCPCS 33463
|
| Hospital Charge Code |
76101292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,729.79 |
| Max. Negotiated Rate |
$5,350.00 |
| Rate for Payer: Aetna Commercial |
$4,954.11
|
| Rate for Payer: Anthem Medicaid |
$1,729.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,350.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,401.67
|
| Rate for Payer: Healthspan PPO |
$4,870.86
|
| Rate for Payer: Humana Medicaid |
$1,729.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,342.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,764.39
|
| Rate for Payer: Molina Healthcare Passport |
$1,729.79
|
| Rate for Payer: Multiplan PHCS |
$3,210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,745.00
|
| Rate for Payer: UHCCP Medicaid |
$1,872.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,747.09
|
|
|
VALVULOPLASTY TRICUSPID
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS 33463
|
| Hospital Charge Code |
76101292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
VALVULOPLASTY TRICUSPID(P
|
Professional
|
Both
|
$5,350.00
|
|
|
Service Code
|
HCPCS 33463
|
| Hospital Charge Code |
761P1292
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,729.79 |
| Max. Negotiated Rate |
$5,350.00 |
| Rate for Payer: Aetna Commercial |
$4,954.11
|
| Rate for Payer: Anthem Medicaid |
$1,729.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,350.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,401.67
|
| Rate for Payer: Healthspan PPO |
$4,870.86
|
| Rate for Payer: Humana Medicaid |
$1,729.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,342.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,764.39
|
| Rate for Payer: Molina Healthcare Passport |
$1,729.79
|
| Rate for Payer: Multiplan PHCS |
$3,210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,745.00
|
| Rate for Payer: UHCCP Medicaid |
$1,872.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,747.09
|
|
|
VANCOCIN (VANCOMYCI 500MG/10ML
|
Facility
|
OP
|
$78.95
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002409
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$75.79 |
| Rate for Payer: Aetna Commercial |
$60.79
|
| Rate for Payer: Anthem Medicaid |
$27.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.58
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cigna Commercial |
$65.53
|
| Rate for Payer: First Health Commercial |
$75.00
|
| Rate for Payer: Humana Commercial |
$67.11
|
| Rate for Payer: Humana KY Medicaid |
$27.15
|
| Rate for Payer: Kentucky WC Medicaid |
$27.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.48
|
| Rate for Payer: Ohio Health Group HMO |
$59.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.47
|
| Rate for Payer: PHCS Commercial |
$75.79
|
| Rate for Payer: United Healthcare All Payer |
$69.48
|
|
|
VANCOCIN (VANCOMYCI 500MG/10ML
|
Facility
|
IP
|
$78.95
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002409
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$75.79 |
| Rate for Payer: Aetna Commercial |
$60.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.58
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cigna Commercial |
$65.53
|
| Rate for Payer: First Health Commercial |
$75.00
|
| Rate for Payer: Humana Commercial |
$67.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.48
|
| Rate for Payer: Ohio Health Group HMO |
$59.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.47
|
| Rate for Payer: PHCS Commercial |
$75.79
|
| Rate for Payer: United Healthcare All Payer |
$69.48
|
|
|
VANCOCIN (VANCOMYCIN 1GM/20ML
|
Facility
|
OP
|
$33.04
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$31.72 |
| Rate for Payer: Aetna Commercial |
$25.44
|
| Rate for Payer: Aetna Commercial |
$94.74
|
| Rate for Payer: Aetna Commercial |
$70.10
|
| Rate for Payer: Anthem Medicaid |
$31.31
|
| Rate for Payer: Anthem Medicaid |
$11.36
|
| Rate for Payer: Anthem Medicaid |
$42.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.97
|
| Rate for Payer: Cash Price |
$45.52
|
| Rate for Payer: Cash Price |
$61.52
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cigna Commercial |
$27.42
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Cigna Commercial |
$75.56
|
| Rate for Payer: First Health Commercial |
$86.49
|
| Rate for Payer: First Health Commercial |
$116.89
|
| Rate for Payer: First Health Commercial |
$31.39
|
| Rate for Payer: Humana Commercial |
$77.38
|
| Rate for Payer: Humana Commercial |
$104.58
|
| Rate for Payer: Humana Commercial |
$28.08
|
| Rate for Payer: Humana KY Medicaid |
$11.36
|
| Rate for Payer: Humana KY Medicaid |
$42.31
|
| Rate for Payer: Humana KY Medicaid |
$31.31
|
| Rate for Payer: Kentucky WC Medicaid |
$31.63
|
| Rate for Payer: Kentucky WC Medicaid |
$11.48
|
| Rate for Payer: Kentucky WC Medicaid |
$42.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.12
|
| Rate for Payer: Ohio Health Group HMO |
$68.28
|
| Rate for Payer: Ohio Health Group HMO |
$92.28
|
| Rate for Payer: Ohio Health Group HMO |
$24.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.22
|
| Rate for Payer: PHCS Commercial |
$118.12
|
| Rate for Payer: PHCS Commercial |
$87.40
|
| Rate for Payer: PHCS Commercial |
$31.72
|
| Rate for Payer: United Healthcare All Payer |
$80.12
|
| Rate for Payer: United Healthcare All Payer |
$29.08
|
| Rate for Payer: United Healthcare All Payer |
$108.28
|
|
|
VANCOCIN (VANCOMYCIN 1GM/20ML
|
Facility
|
IP
|
$123.04
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$118.12 |
| Rate for Payer: Aetna Commercial |
$94.74
|
| Rate for Payer: Aetna Commercial |
$70.10
|
| Rate for Payer: Aetna Commercial |
$25.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.01
|
| Rate for Payer: Cash Price |
$45.52
|
| Rate for Payer: Cash Price |
$61.52
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cigna Commercial |
$27.42
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Cigna Commercial |
$75.56
|
| Rate for Payer: First Health Commercial |
$86.49
|
| Rate for Payer: First Health Commercial |
$116.89
|
| Rate for Payer: First Health Commercial |
$31.39
|
| Rate for Payer: Humana Commercial |
$77.38
|
| Rate for Payer: Humana Commercial |
$104.58
|
| Rate for Payer: Humana Commercial |
$28.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.08
|
| Rate for Payer: Ohio Health Group HMO |
$92.28
|
| Rate for Payer: Ohio Health Group HMO |
$24.78
|
| Rate for Payer: Ohio Health Group HMO |
$68.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.22
|
| Rate for Payer: PHCS Commercial |
$118.12
|
| Rate for Payer: PHCS Commercial |
$87.40
|
| Rate for Payer: PHCS Commercial |
$31.72
|
| Rate for Payer: United Healthcare All Payer |
$29.08
|
| Rate for Payer: United Healthcare All Payer |
$108.28
|
| Rate for Payer: United Healthcare All Payer |
$80.12
|
|
|
VANCOMYCIN 125MG CAPSULE
|
Facility
|
OP
|
$10.50
|
|
|
Service Code
|
NDC 68180016613
|
| Hospital Charge Code |
25003553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Anthem Medicaid |
$3.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.19
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cigna Commercial |
$8.72
|
| Rate for Payer: First Health Commercial |
$9.98
|
| Rate for Payer: Humana Commercial |
$8.92
|
| Rate for Payer: Humana KY Medicaid |
$3.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.24
|
| Rate for Payer: Ohio Health Group HMO |
$7.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.26
|
| Rate for Payer: PHCS Commercial |
$10.08
|
| Rate for Payer: United Healthcare All Payer |
$9.24
|
|
|
VANCOMYCIN 125MG CAPSULE
|
Facility
|
IP
|
$10.50
|
|
|
Service Code
|
NDC 68180016613
|
| Hospital Charge Code |
25003553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.19
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cigna Commercial |
$8.72
|
| Rate for Payer: First Health Commercial |
$9.98
|
| Rate for Payer: Humana Commercial |
$8.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.24
|
| Rate for Payer: Ohio Health Group HMO |
$7.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.26
|
| Rate for Payer: PHCS Commercial |
$10.08
|
| Rate for Payer: United Healthcare All Payer |
$9.24
|
|
|
VANCOMYCIN 1.75GM PREMIX IVPB
|
Facility
|
OP
|
$181.59
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
25002412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.61 |
| Max. Negotiated Rate |
$174.33 |
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: Anthem Medicaid |
$62.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.64
|
| Rate for Payer: Cash Price |
$90.80
|
| Rate for Payer: Cigna Commercial |
$150.72
|
| Rate for Payer: First Health Commercial |
$172.51
|
| Rate for Payer: Humana Commercial |
$154.35
|
| Rate for Payer: Humana KY Medicaid |
$62.45
|
| Rate for Payer: Kentucky WC Medicaid |
$63.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.80
|
| Rate for Payer: Ohio Health Group HMO |
$136.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.29
|
| Rate for Payer: PHCS Commercial |
$174.33
|
| Rate for Payer: United Healthcare All Payer |
$159.80
|
|
