|
VASC VEINMAP DIALYSIS ACCESS(T
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
921T0025
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$198.09 |
| Max. Negotiated Rate |
$552.96 |
| Rate for Payer: Aetna Commercial |
$443.52
|
| Rate for Payer: Anthem Medicaid |
$198.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$449.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cigna Commercial |
$478.08
|
| Rate for Payer: First Health Commercial |
$547.20
|
| Rate for Payer: Humana Commercial |
$489.60
|
| Rate for Payer: Humana KY Medicaid |
$198.09
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$200.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$472.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$425.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$202.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.88
|
| Rate for Payer: Ohio Health Group HMO |
$432.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$397.44
|
| Rate for Payer: PHCS Commercial |
$552.96
|
| Rate for Payer: United Healthcare All Payer |
$506.88
|
|
|
VASECTOMY IN OFFICE SP
|
Professional
|
Both
|
$750.00
|
|
| Hospital Charge Code |
22200717
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)
|
Facility
|
OP
|
$2,649.89
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,892.78 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
|
|
VASELINE(PETROLATUM) OINT 5GM
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 84521000686
|
| Hospital Charge Code |
27000219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna Commercial |
$0.22
|
| Rate for Payer: First Health Commercial |
$0.26
|
| Rate for Payer: Humana Commercial |
$0.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.24
|
| Rate for Payer: Ohio Health Group HMO |
$0.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.19
|
| Rate for Payer: PHCS Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Payer |
$0.24
|
|
|
VASELINE(PETROLATUM) OINT 5GM
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 84521000686
|
| Hospital Charge Code |
27000219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Anthem Medicaid |
$0.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.21
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna Commercial |
$0.22
|
| Rate for Payer: First Health Commercial |
$0.26
|
| Rate for Payer: Humana Commercial |
$0.23
|
| Rate for Payer: Humana KY Medicaid |
$0.09
|
| Rate for Payer: Kentucky WC Medicaid |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.24
|
| Rate for Payer: Ohio Health Group HMO |
$0.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.19
|
| Rate for Payer: PHCS Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Payer |
$0.24
|
|
|
VASELINE(PETROLATUM) OINT 5GM
|
Facility
|
OP
|
$3.85
|
|
| Hospital Charge Code |
27000219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Anthem Medicaid |
$1.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.00
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna Commercial |
$3.20
|
| Rate for Payer: First Health Commercial |
$3.66
|
| Rate for Payer: Humana Commercial |
$3.27
|
| Rate for Payer: Humana KY Medicaid |
$1.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.39
|
| Rate for Payer: Ohio Health Group HMO |
$2.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.66
|
| Rate for Payer: PHCS Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Payer |
$3.39
|
|
|
VASELINE(PETROLATUM) OINT 5GM
|
Facility
|
IP
|
$3.85
|
|
| Hospital Charge Code |
27000219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.00
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cigna Commercial |
$3.20
|
| Rate for Payer: First Health Commercial |
$3.66
|
| Rate for Payer: Humana Commercial |
$3.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.39
|
| Rate for Payer: Ohio Health Group HMO |
$2.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.66
|
| Rate for Payer: PHCS Commercial |
$3.70
|
| Rate for Payer: United Healthcare All Payer |
$3.39
|
|
|
VASELINE(PETROLATUM) OINT 5GM
|
Professional
|
Both
|
$3.85
|
|
| Hospital Charge Code |
27000219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Multiplan PHCS |
$2.31
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.69
|
| Rate for Payer: UHCCP Medicaid |
$1.35
|
|
|
VASOPNEUMATIC DEV INTERM/SEQ
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 97016
|
| Hospital Charge Code |
42000008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Anthem Medicaid |
$52.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.34
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$126.99
|
| Rate for Payer: First Health Commercial |
$145.35
|
| Rate for Payer: Humana Commercial |
$130.05
|
| Rate for Payer: Humana KY Medicaid |
$52.62
|
| Rate for Payer: Kentucky WC Medicaid |
$53.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$125.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$53.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$134.64
|
| Rate for Payer: Ohio Health Group HMO |
$114.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.57
|
| Rate for Payer: PHCS Commercial |
$146.88
|
| Rate for Payer: United Healthcare All Payer |
$134.64
|
|
|
VASOPNEUMATIC DEV INTERM/SEQ
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 97016
|
| Hospital Charge Code |
42000008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.34
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$126.99
|
| Rate for Payer: First Health Commercial |
$145.35
|
| Rate for Payer: Humana Commercial |
$130.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$125.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$134.64
|
| Rate for Payer: Ohio Health Group HMO |
$114.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.57
|
| Rate for Payer: PHCS Commercial |
$146.88
|
| Rate for Payer: United Healthcare All Payer |
$134.64
|
|
|
VASOPNEUMATIC DEV INTERM/SEQUE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 97016
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.34
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$126.99
|
| Rate for Payer: First Health Commercial |
$145.35
|
| Rate for Payer: Humana Commercial |
$130.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$125.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$134.64
|
| Rate for Payer: Ohio Health Group HMO |
$114.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.57
|
| Rate for Payer: PHCS Commercial |
$146.88
|
| Rate for Payer: United Healthcare All Payer |
$134.64
|
|
|
VASOPNEUMATIC DEV INTERM/SEQUE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 97016
|
| Hospital Charge Code |
43000005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Anthem Medicaid |
$52.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.34
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$126.99
|
| Rate for Payer: First Health Commercial |
$145.35
|
| Rate for Payer: Humana Commercial |
$130.05
|
| Rate for Payer: Humana KY Medicaid |
$52.62
|
| Rate for Payer: Kentucky WC Medicaid |
$53.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$125.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$53.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$134.64
|
| Rate for Payer: Ohio Health Group HMO |
$114.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.57
|
| Rate for Payer: PHCS Commercial |
$146.88
|
| Rate for Payer: United Healthcare All Payer |
$134.64
|
|
|
VASOPRESSI IN NS 100UN/100MLIV
|
Facility
|
OP
|
$103.22
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003561
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$99.09 |
| Rate for Payer: Aetna Commercial |
$79.48
|
| Rate for Payer: Anthem Medicaid |
$35.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.51
|
| Rate for Payer: Cash Price |
$51.61
|
| Rate for Payer: Cigna Commercial |
$85.67
|
| Rate for Payer: First Health Commercial |
$98.06
|
| Rate for Payer: Humana Commercial |
$87.74
|
| Rate for Payer: Humana KY Medicaid |
$35.50
|
| Rate for Payer: Kentucky WC Medicaid |
$35.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.83
|
| Rate for Payer: Ohio Health Group HMO |
$77.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.22
|
| Rate for Payer: PHCS Commercial |
$99.09
|
| Rate for Payer: United Healthcare All Payer |
$90.83
|
|
|
VASOPRESSI IN NS 100UN/100MLIV
|
Facility
|
IP
|
$103.22
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003561
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$99.09 |
| Rate for Payer: Aetna Commercial |
$79.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.51
|
| Rate for Payer: Cash Price |
$51.61
|
| Rate for Payer: Cigna Commercial |
$85.67
|
| Rate for Payer: First Health Commercial |
$98.06
|
| Rate for Payer: Humana Commercial |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$84.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$90.83
|
| Rate for Payer: Ohio Health Group HMO |
$77.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.22
|
| Rate for Payer: PHCS Commercial |
$99.09
|
| Rate for Payer: United Healthcare All Payer |
$90.83
|
|
|
VASOPRESSIN(GEN)1u(20uSDV)
|
Facility
|
IP
|
$119.06
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
25003357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna Commercial |
$91.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.87
|
| Rate for Payer: Cash Price |
$59.53
|
| Rate for Payer: Cigna Commercial |
$98.82
|
| Rate for Payer: First Health Commercial |
$113.11
|
| Rate for Payer: Humana Commercial |
$101.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.77
|
| Rate for Payer: Ohio Health Group HMO |
$89.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.15
|
| Rate for Payer: PHCS Commercial |
$114.30
|
| Rate for Payer: United Healthcare All Payer |
$104.77
|
|
|
VASOPRESSIN(GEN)1u(20uSDV)
|
Facility
|
OP
|
$119.06
|
|
|
Service Code
|
HCPCS J2598
|
| Hospital Charge Code |
25003357
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$114.30 |
| Rate for Payer: Aetna Commercial |
$91.68
|
| Rate for Payer: Anthem Medicaid |
$40.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.87
|
| Rate for Payer: Cash Price |
$59.53
|
| Rate for Payer: Cigna Commercial |
$98.82
|
| Rate for Payer: First Health Commercial |
$113.11
|
| Rate for Payer: Humana Commercial |
$101.20
|
| Rate for Payer: Humana KY Medicaid |
$40.94
|
| Rate for Payer: Kentucky WC Medicaid |
$41.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.77
|
| Rate for Payer: Ohio Health Group HMO |
$89.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.15
|
| Rate for Payer: PHCS Commercial |
$114.30
|
| Rate for Payer: United Healthcare All Payer |
$104.77
|
|
|
VASOTEC 2.5 MG/2 ML VIAL
|
Facility
|
OP
|
$116.48
|
|
|
Service Code
|
NDC 143978610
|
| Hospital Charge Code |
25003564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$111.82 |
| Rate for Payer: Aetna Commercial |
$89.69
|
| Rate for Payer: Anthem Medicaid |
$40.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.85
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cigna Commercial |
$96.68
|
| Rate for Payer: First Health Commercial |
$110.66
|
| Rate for Payer: Humana Commercial |
$99.01
|
| Rate for Payer: Humana KY Medicaid |
$40.06
|
| Rate for Payer: Kentucky WC Medicaid |
$40.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.50
|
| Rate for Payer: Ohio Health Group HMO |
$87.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.37
|
| Rate for Payer: PHCS Commercial |
$111.82
|
| Rate for Payer: United Healthcare All Payer |
$102.50
|
|
|
VASOTEC 2.5 MG/2 ML VIAL
|
Facility
|
IP
|
$116.48
|
|
|
Service Code
|
NDC 143978610
|
| Hospital Charge Code |
25003564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$111.82 |
| Rate for Payer: Aetna Commercial |
$89.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.85
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cigna Commercial |
$96.68
|
| Rate for Payer: First Health Commercial |
$110.66
|
| Rate for Payer: Humana Commercial |
$99.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.50
|
| Rate for Payer: Ohio Health Group HMO |
$87.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.37
|
| Rate for Payer: PHCS Commercial |
$111.82
|
| Rate for Payer: United Healthcare All Payer |
$102.50
|
|
|
VASOTEC (ENALAPRIL) 10MG/1TAB
|
Facility
|
IP
|
$4.78
|
|
|
Service Code
|
NDC 68682071201
|
| Hospital Charge Code |
25001653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna Commercial |
$3.97
|
| Rate for Payer: First Health Commercial |
$4.54
|
| Rate for Payer: Humana Commercial |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.21
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.30
|
| Rate for Payer: PHCS Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Payer |
$4.21
|
|
|
VASOTEC (ENALAPRIL) 10MG/1TAB
|
Facility
|
OP
|
$4.78
|
|
|
Service Code
|
NDC 68682071201
|
| Hospital Charge Code |
25001653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna Commercial |
$3.97
|
| Rate for Payer: First Health Commercial |
$4.54
|
| Rate for Payer: Humana Commercial |
$4.06
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.21
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.30
|
| Rate for Payer: PHCS Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Payer |
$4.21
|
|
|
VASOTEC (ENALAPRIL) 1.25MG/ML
|
Facility
|
OP
|
$112.31
|
|
|
Service Code
|
NDC 143978701
|
| Hospital Charge Code |
25003563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.69 |
| Max. Negotiated Rate |
$107.82 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Anthem Medicaid |
$38.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.60
|
| Rate for Payer: Cash Price |
$56.16
|
| Rate for Payer: Cigna Commercial |
$93.22
|
| Rate for Payer: First Health Commercial |
$106.69
|
| Rate for Payer: Humana Commercial |
$95.46
|
| Rate for Payer: Humana KY Medicaid |
$38.62
|
| Rate for Payer: Kentucky WC Medicaid |
$39.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.83
|
| Rate for Payer: Ohio Health Group HMO |
$84.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.49
|
| Rate for Payer: PHCS Commercial |
$107.82
|
| Rate for Payer: United Healthcare All Payer |
$98.83
|
|
|
VASOTEC (ENALAPRIL) 1.25MG/ML
|
Facility
|
IP
|
$112.31
|
|
|
Service Code
|
NDC 143978701
|
| Hospital Charge Code |
25003563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.69 |
| Max. Negotiated Rate |
$107.82 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.60
|
| Rate for Payer: Cash Price |
$56.16
|
| Rate for Payer: Cigna Commercial |
$93.22
|
| Rate for Payer: First Health Commercial |
$106.69
|
| Rate for Payer: Humana Commercial |
$95.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.83
|
| Rate for Payer: Ohio Health Group HMO |
$84.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.49
|
| Rate for Payer: PHCS Commercial |
$107.82
|
| Rate for Payer: United Healthcare All Payer |
$98.83
|
|
|
VASOTEC (ENALAPRIL) 20MG/1TAB
|
Facility
|
IP
|
$5.03
|
|
|
Service Code
|
NDC 68682071301
|
| Hospital Charge Code |
25001654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.47
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
VASOTEC (ENALAPRIL) 20MG/1TAB
|
Facility
|
OP
|
$5.03
|
|
|
Service Code
|
NDC 68682071301
|
| Hospital Charge Code |
25001654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.47
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
VASOTEC (ENALAPRIL) 2.5MG/1TAB
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 68682071001
|
| Hospital Charge Code |
25001655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: First Health Commercial |
$4.41
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.08
|
| Rate for Payer: Ohio Health Group HMO |
$3.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.20
|
| Rate for Payer: PHCS Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Payer |
$4.08
|
|
