|
VITALITY HE DR DC/LEAD 8806
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY HE DR DC/LEAD 8806
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY HE DR DC/LEAD 8807
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY HE DR DC/LEAD 8807
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY HE DR DC/LEAD 8808
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY HE DR DC/LEAD 8808
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY HE DR DC/LEAD 8809
|
Facility
|
IP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITALITY HE DR DC/LEAD 8809
|
Facility
|
OP
|
$94,300.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,259.00 |
| Max. Negotiated Rate |
$90,528.00 |
| Rate for Payer: Aetna Commercial |
$72,611.00
|
| Rate for Payer: Anthem Medicaid |
$32,429.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,554.00
|
| Rate for Payer: Cash Price |
$47,150.00
|
| Rate for Payer: Cigna Commercial |
$78,269.00
|
| Rate for Payer: First Health Commercial |
$89,585.00
|
| Rate for Payer: Humana Commercial |
$80,155.00
|
| Rate for Payer: Humana KY Medicaid |
$32,429.77
|
| Rate for Payer: Kentucky WC Medicaid |
$32,759.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,326.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,593.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,984.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,259.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,233.00
|
| Rate for Payer: PHCS Commercial |
$90,528.00
|
| Rate for Payer: United Healthcare All Payer |
$82,984.00
|
|
|
VITAMIN A 10000 IU CAPS
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 87701040725
|
| Hospital Charge Code |
25001685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
VITAMIN A 10000 IU CAPS
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 87701040725
|
| Hospital Charge Code |
25001685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
|
|
VITAMIN A&D OINTMENT 113gm
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
NDC 41100081124
|
| Hospital Charge Code |
25004411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.89
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cigna Commercial |
$3.08
|
| Rate for Payer: First Health Commercial |
$3.52
|
| Rate for Payer: Humana Commercial |
$3.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.26
|
| Rate for Payer: Ohio Health Group HMO |
$2.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.15
|
| Rate for Payer: PHCS Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Payer |
$3.26
|
|
|
VITAMIN A&D OINTMENT 113gm
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
NDC 41100081124
|
| Hospital Charge Code |
25004411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Anthem Medicaid |
$1.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.89
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cigna Commercial |
$3.08
|
| Rate for Payer: First Health Commercial |
$3.52
|
| Rate for Payer: Humana Commercial |
$3.15
|
| Rate for Payer: Humana KY Medicaid |
$1.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.26
|
| Rate for Payer: Ohio Health Group HMO |
$2.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.15
|
| Rate for Payer: PHCS Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Payer |
$3.26
|
|
|
VITAMIN A PALMIT50000 U/ML VL
|
Facility
|
OP
|
$1,660.75
|
|
|
Service Code
|
NDC 70199002611
|
| Hospital Charge Code |
25003580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$215.90 |
| Max. Negotiated Rate |
$1,594.32 |
| Rate for Payer: Aetna Commercial |
$1,278.78
|
| Rate for Payer: Anthem Medicaid |
$571.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,295.38
|
| Rate for Payer: Cash Price |
$830.38
|
| Rate for Payer: Cigna Commercial |
$1,378.42
|
| Rate for Payer: First Health Commercial |
$1,577.71
|
| Rate for Payer: Humana Commercial |
$1,411.64
|
| Rate for Payer: Humana KY Medicaid |
$571.13
|
| Rate for Payer: Kentucky WC Medicaid |
$576.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,361.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,225.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$498.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$582.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,461.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,245.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$332.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.83
|
| Rate for Payer: PHCS Commercial |
$1,594.32
|
| Rate for Payer: United Healthcare All Payer |
$1,461.46
|
|
|
VITAMIN A PALMIT50000 U/ML VL
|
Facility
|
IP
|
$1,660.75
|
|
|
Service Code
|
NDC 70199002611
|
| Hospital Charge Code |
25003580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$215.90 |
| Max. Negotiated Rate |
$1,594.32 |
| Rate for Payer: Aetna Commercial |
$1,278.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,295.38
|
| Rate for Payer: Cash Price |
$830.38
|
| Rate for Payer: Cigna Commercial |
$1,378.42
|
| Rate for Payer: First Health Commercial |
$1,577.71
|
| Rate for Payer: Humana Commercial |
$1,411.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,361.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,225.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$498.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,461.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,245.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$332.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.83
|
| Rate for Payer: PHCS Commercial |
$1,594.32
|
| Rate for Payer: United Healthcare All Payer |
$1,461.46
|
|
|
VITAMIN B12
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
30000302
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: Aetna Commercial |
$75.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.69
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$81.34
|
| Rate for Payer: First Health Commercial |
$93.10
|
| Rate for Payer: Humana Commercial |
$83.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.24
|
| Rate for Payer: Ohio Health Group HMO |
$73.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.38
|
| Rate for Payer: PHCS Commercial |
$94.08
|
| Rate for Payer: United Healthcare All Payer |
$86.24
|
|
|
VITAMIN B12
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
30000302
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: Aetna Commercial |
$75.46
|
| Rate for Payer: Anthem Medicaid |
$15.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.08
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$81.34
|
| Rate for Payer: First Health Commercial |
$93.10
|
| Rate for Payer: Humana Commercial |
$83.30
|
| Rate for Payer: Humana KY Medicaid |
$15.08
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$15.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.24
|
| Rate for Payer: Ohio Health Group HMO |
$73.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.38
|
| Rate for Payer: PHCS Commercial |
$94.08
|
| Rate for Payer: United Healthcare All Payer |
$86.24
|
|
|
VITAMIN B12
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
30000302
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Aetna Commercial |
$24.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$13.42
|
| Rate for Payer: Healthspan PPO |
$15.79
|
| Rate for Payer: Multiplan PHCS |
$58.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$68.60
|
| Rate for Payer: UHCCP Medicaid |
$34.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.05
|
|
|
VITAMIN B12 1000MCG SLG TAB
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 31604002717
|
| Hospital Charge Code |
25001688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.51
|
| Rate for Payer: First Health Commercial |
$4.02
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.72
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.06
|
| Rate for Payer: United Healthcare All Payer |
$3.72
|
|
|
VITAMIN B12 1000MCG SLG TAB
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 31604002717
|
| Hospital Charge Code |
25001688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.51
|
| Rate for Payer: First Health Commercial |
$4.02
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.72
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.06
|
| Rate for Payer: United Healthcare All Payer |
$3.72
|
|
|
VITAMIN B 12 250MCG TABLET
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 50268085315
|
| Hospital Charge Code |
25001686
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
VITAMIN B 12 250MCG TABLET
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 50268085315
|
| Hospital Charge Code |
25001686
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
VITAMIN D 1000 UNIT TABLET
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
25001689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
VITAMIN D 1000 UNIT TABLET
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
25001689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
VITAMIN D 400 IU TABL
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
NDC 77333094810
|
| Hospital Charge Code |
25001690
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
|
|
VITAMIN D 400 IU TABL
|
Facility
|
IP
|
$4.43
|
|
|
Service Code
|
NDC 77333094810
|
| Hospital Charge Code |
25001690
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
