|
ACTIVASE 1mg (5mg VIAL)
|
Facility
|
IP
|
$2,398.11
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
25003888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$311.75 |
| Max. Negotiated Rate |
$2,302.19 |
| Rate for Payer: Aetna Commercial |
$1,846.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,870.53
|
| Rate for Payer: Cash Price |
$1,199.06
|
| Rate for Payer: Cigna Commercial |
$1,990.43
|
| Rate for Payer: First Health Commercial |
$2,278.20
|
| Rate for Payer: Humana Commercial |
$2,038.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,966.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,769.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$719.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,110.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,798.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$479.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$311.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$743.41
|
| Rate for Payer: PHCS Commercial |
$2,302.19
|
| Rate for Payer: United Healthcare All Payer |
$2,110.34
|
|
|
ACTIVASE 50MG VIAL
|
Facility
|
OP
|
$23,980.98
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
25003890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.97 |
| Max. Negotiated Rate |
$23,021.74 |
| Rate for Payer: Aetna Commercial |
$18,465.35
|
| Rate for Payer: Anthem Medicaid |
$8,247.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$88.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,705.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$124.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.11
|
| Rate for Payer: Cash Price |
$11,990.49
|
| Rate for Payer: Cash Price |
$11,990.49
|
| Rate for Payer: Cigna Commercial |
$19,904.21
|
| Rate for Payer: First Health Commercial |
$22,781.93
|
| Rate for Payer: Humana Commercial |
$20,383.83
|
| Rate for Payer: Humana KY Medicaid |
$8,247.06
|
| Rate for Payer: Humana Medicare Advantage |
$88.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,330.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,412.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.26
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.10
|
| Rate for Payer: PHCS Commercial |
$23,021.74
|
| Rate for Payer: United Healthcare All Payer |
$21,103.26
|
|
|
ACTIVASE 50MG VIAL
|
Facility
|
IP
|
$23,980.98
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
25003890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,117.53 |
| Max. Negotiated Rate |
$23,021.74 |
| Rate for Payer: Aetna Commercial |
$18,465.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,705.16
|
| Rate for Payer: Cash Price |
$11,990.49
|
| Rate for Payer: Cigna Commercial |
$19,904.21
|
| Rate for Payer: First Health Commercial |
$22,781.93
|
| Rate for Payer: Humana Commercial |
$20,383.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.26
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.10
|
| Rate for Payer: PHCS Commercial |
$23,021.74
|
| Rate for Payer: United Healthcare All Payer |
$21,103.26
|
|
|
ACTIVATED CLOTTING TIME (ACT)
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 85347
|
| Hospital Charge Code |
30000598
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
ACTIVATED CLOTTING TIME (ACT)
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 85347
|
| Hospital Charge Code |
30000598
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$4.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.28
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Humana KY Medicaid |
$4.28
|
| Rate for Payer: Humana Medicare Advantage |
$4.28
|
| Rate for Payer: Kentucky WC Medicaid |
$4.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
ACTONEL 150MG TABLET
|
Facility
|
OP
|
$539.33
|
|
|
Service Code
|
NDC 430047801
|
| Hospital Charge Code |
25000149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.11 |
| Max. Negotiated Rate |
$517.76 |
| Rate for Payer: Aetna Commercial |
$415.28
|
| Rate for Payer: Anthem Medicaid |
$185.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$420.68
|
| Rate for Payer: Cash Price |
$269.66
|
| Rate for Payer: Cigna Commercial |
$447.64
|
| Rate for Payer: First Health Commercial |
$512.36
|
| Rate for Payer: Humana Commercial |
$458.43
|
| Rate for Payer: Humana KY Medicaid |
$185.48
|
| Rate for Payer: Kentucky WC Medicaid |
$187.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$442.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$474.61
|
| Rate for Payer: Ohio Health Group HMO |
$404.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.19
|
| Rate for Payer: PHCS Commercial |
$517.76
|
| Rate for Payer: United Healthcare All Payer |
$474.61
|
|
|
ACTONEL 150MG TABLET
|
Facility
|
IP
|
$539.33
|
|
|
Service Code
|
NDC 430047801
|
| Hospital Charge Code |
25000149
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.11 |
| Max. Negotiated Rate |
$517.76 |
| Rate for Payer: Aetna Commercial |
$415.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$420.68
|
| Rate for Payer: Cash Price |
$269.66
|
| Rate for Payer: Cigna Commercial |
$447.64
|
| Rate for Payer: First Health Commercial |
$512.36
|
| Rate for Payer: Humana Commercial |
$458.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$442.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$474.61
|
| Rate for Payer: Ohio Health Group HMO |
$404.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.19
|
| Rate for Payer: PHCS Commercial |
$517.76
|
| Rate for Payer: United Healthcare All Payer |
$474.61
|
|
|
ACTONEL(ISEDRONATE)30MG TAB
|
Facility
|
OP
|
$87.56
|
|
|
Service Code
|
NDC 93310056
|
| Hospital Charge Code |
25000150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$84.06 |
| Rate for Payer: Aetna Commercial |
$67.42
|
| Rate for Payer: Anthem Medicaid |
$30.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.30
|
| Rate for Payer: Cash Price |
$43.78
|
| Rate for Payer: Cigna Commercial |
$72.67
|
| Rate for Payer: First Health Commercial |
$83.18
|
| Rate for Payer: Humana Commercial |
$74.43
|
| Rate for Payer: Humana KY Medicaid |
$30.11
|
| Rate for Payer: Kentucky WC Medicaid |
$30.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.05
|
| Rate for Payer: Ohio Health Group HMO |
$65.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.14
|
| Rate for Payer: PHCS Commercial |
$84.06
|
| Rate for Payer: United Healthcare All Payer |
$77.05
|
|
|
ACTONEL(ISEDRONATE)30MG TAB
|
Facility
|
IP
|
$87.56
|
|
|
Service Code
|
NDC 93310056
|
| Hospital Charge Code |
25000150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$84.06 |
| Rate for Payer: Aetna Commercial |
$67.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.30
|
| Rate for Payer: Cash Price |
$43.78
|
| Rate for Payer: Cigna Commercial |
$72.67
|
| Rate for Payer: First Health Commercial |
$83.18
|
| Rate for Payer: Humana Commercial |
$74.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.05
|
| Rate for Payer: Ohio Health Group HMO |
$65.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.14
|
| Rate for Payer: PHCS Commercial |
$84.06
|
| Rate for Payer: United Healthcare All Payer |
$77.05
|
|
|
ACTONEL(RISEDRON SOD) 35MG TAB
|
Facility
|
OP
|
$157.25
|
|
|
Service Code
|
NDC 430047203
|
| Hospital Charge Code |
25000151
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$150.96 |
| Rate for Payer: Aetna Commercial |
$121.08
|
| Rate for Payer: Anthem Medicaid |
$54.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.66
|
| Rate for Payer: Cash Price |
$78.62
|
| Rate for Payer: Cigna Commercial |
$130.52
|
| Rate for Payer: First Health Commercial |
$149.39
|
| Rate for Payer: Humana Commercial |
$133.66
|
| Rate for Payer: Humana KY Medicaid |
$54.08
|
| Rate for Payer: Kentucky WC Medicaid |
$54.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$55.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.38
|
| Rate for Payer: Ohio Health Group HMO |
$117.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.75
|
| Rate for Payer: PHCS Commercial |
$150.96
|
| Rate for Payer: United Healthcare All Payer |
$138.38
|
|
|
ACTONEL(RISEDRON SOD) 35MG TAB
|
Facility
|
IP
|
$157.25
|
|
|
Service Code
|
NDC 430047203
|
| Hospital Charge Code |
25000151
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$150.96 |
| Rate for Payer: Aetna Commercial |
$121.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.66
|
| Rate for Payer: Cash Price |
$78.62
|
| Rate for Payer: Cigna Commercial |
$130.52
|
| Rate for Payer: First Health Commercial |
$149.39
|
| Rate for Payer: Humana Commercial |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.38
|
| Rate for Payer: Ohio Health Group HMO |
$117.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.75
|
| Rate for Payer: PHCS Commercial |
$150.96
|
| Rate for Payer: United Healthcare All Payer |
$138.38
|
|
|
ACTOS (PIOGLITAZOME) 15MG TAB
|
Facility
|
IP
|
$9.05
|
|
|
Service Code
|
NDC 60687039101
|
| Hospital Charge Code |
25000152
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.69 |
| Rate for Payer: Aetna Commercial |
$6.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.06
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna Commercial |
$7.51
|
| Rate for Payer: First Health Commercial |
$8.60
|
| Rate for Payer: Humana Commercial |
$7.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.96
|
| Rate for Payer: Ohio Health Group HMO |
$6.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.81
|
| Rate for Payer: PHCS Commercial |
$8.69
|
| Rate for Payer: United Healthcare All Payer |
$7.96
|
|
|
ACTOS (PIOGLITAZOME) 15MG TAB
|
Facility
|
OP
|
$9.05
|
|
|
Service Code
|
NDC 60687039101
|
| Hospital Charge Code |
25000152
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$8.69 |
| Rate for Payer: Anthem Medicaid |
$3.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.06
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cigna Commercial |
$7.51
|
| Rate for Payer: First Health Commercial |
$8.60
|
| Rate for Payer: Humana Commercial |
$7.69
|
| Rate for Payer: Humana KY Medicaid |
$3.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.42
|
| Rate for Payer: Aetna Commercial |
$6.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.96
|
| Rate for Payer: Ohio Health Group HMO |
$6.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.81
|
| Rate for Payer: PHCS Commercial |
$8.69
|
| Rate for Payer: United Healthcare All Payer |
$7.96
|
|
|
ACULAR 0.5% OPHTH SOL
|
Facility
|
OP
|
$1.81
|
|
|
Service Code
|
NDC 42571013725
|
| Hospital Charge Code |
25000153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Anthem Medicaid |
$0.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.41
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: First Health Commercial |
$1.72
|
| Rate for Payer: Humana Commercial |
$1.54
|
| Rate for Payer: Humana KY Medicaid |
$0.62
|
| Rate for Payer: Kentucky WC Medicaid |
$0.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.59
|
| Rate for Payer: Ohio Health Group HMO |
$1.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.56
|
| Rate for Payer: PHCS Commercial |
$1.74
|
| Rate for Payer: United Healthcare All Payer |
$1.59
|
|
|
ACULAR 0.5% OPHTH SOL
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
NDC 42571013725
|
| Hospital Charge Code |
25000153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.41
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: First Health Commercial |
$1.72
|
| Rate for Payer: Humana Commercial |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.59
|
| Rate for Payer: Ohio Health Group HMO |
$1.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.56
|
| Rate for Payer: PHCS Commercial |
$1.74
|
| Rate for Payer: United Healthcare All Payer |
$1.59
|
|
|
ACULAR LS EYE DROPS 5ML
|
Facility
|
IP
|
$8.75
|
|
|
Service Code
|
NDC 23927705
|
| Hospital Charge Code |
25002801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$6.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.82
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna Commercial |
$7.26
|
| Rate for Payer: First Health Commercial |
$8.31
|
| Rate for Payer: Humana Commercial |
$7.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.70
|
| Rate for Payer: Ohio Health Group HMO |
$6.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.71
|
| Rate for Payer: PHCS Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Payer |
$7.70
|
|
|
ACULAR LS EYE DROPS 5ML
|
Facility
|
OP
|
$8.75
|
|
|
Service Code
|
NDC 23927705
|
| Hospital Charge Code |
25002801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$6.74
|
| Rate for Payer: Anthem Medicaid |
$3.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.82
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cigna Commercial |
$7.26
|
| Rate for Payer: First Health Commercial |
$8.31
|
| Rate for Payer: Humana Commercial |
$7.44
|
| Rate for Payer: Humana KY Medicaid |
$3.01
|
| Rate for Payer: Kentucky WC Medicaid |
$3.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.70
|
| Rate for Payer: Ohio Health Group HMO |
$6.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.71
|
| Rate for Payer: PHCS Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Payer |
$7.70
|
|
|
ACU-LOC .054 KWIRE GUIDE
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem Medicaid |
$635.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Humana KY Medicaid |
$635.18
|
| Rate for Payer: Kentucky WC Medicaid |
$641.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$647.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
ACU-LOC .054 KWIRE GUIDE
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
ACUTE ABDOMEN EXAM
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
32000120
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$587.52 |
| Rate for Payer: Aetna Commercial |
$471.24
|
| Rate for Payer: Anthem Medicaid |
$210.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$477.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$507.96
|
| Rate for Payer: First Health Commercial |
$581.40
|
| Rate for Payer: Humana Commercial |
$520.20
|
| Rate for Payer: Humana KY Medicaid |
$210.47
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$212.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$501.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$451.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$214.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$538.56
|
| Rate for Payer: Ohio Health Group HMO |
$459.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.72
|
| Rate for Payer: PHCS Commercial |
$587.52
|
| Rate for Payer: United Healthcare All Payer |
$538.56
|
|
|
ACUTE ABDOMEN EXAM
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
32000120
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$587.52 |
| Rate for Payer: Aetna Commercial |
$471.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$477.36
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$507.96
|
| Rate for Payer: First Health Commercial |
$581.40
|
| Rate for Payer: Humana Commercial |
$520.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$501.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$451.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$538.56
|
| Rate for Payer: Ohio Health Group HMO |
$459.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.72
|
| Rate for Payer: PHCS Commercial |
$587.52
|
| Rate for Payer: United Healthcare All Payer |
$538.56
|
|
|
ACUTE ABDOMEN EXAM
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
32000120
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$73.59
|
| Rate for Payer: Anthem Medicaid |
$36.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$612.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$67.40
|
| Rate for Payer: Healthspan PPO |
$68.96
|
| Rate for Payer: Humana Medicaid |
$36.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.03
|
| Rate for Payer: Molina Healthcare Passport |
$36.30
|
| Rate for Payer: Multiplan PHCS |
$367.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$428.40
|
| Rate for Payer: UHCCP Medicaid |
$214.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.66
|
|
|
ACUTE ABDOMEN EXAM(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
320P0120
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$73.59
|
| Rate for Payer: Anthem Medicaid |
$36.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$67.40
|
| Rate for Payer: Healthspan PPO |
$68.96
|
| Rate for Payer: Humana Medicaid |
$36.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.03
|
| Rate for Payer: Molina Healthcare Passport |
$36.30
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.66
|
|
|
ACUTE ABDOMEN EXAM(T
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
320T0120
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$69.81 |
| Max. Negotiated Rate |
$515.52 |
| Rate for Payer: Aetna Commercial |
$413.49
|
| Rate for Payer: Anthem Medicaid |
$184.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cigna Commercial |
$445.71
|
| Rate for Payer: First Health Commercial |
$510.15
|
| Rate for Payer: Humana Commercial |
$456.45
|
| Rate for Payer: Humana KY Medicaid |
$184.67
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$186.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$472.56
|
| Rate for Payer: Ohio Health Group HMO |
$402.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.47
|
| Rate for Payer: PHCS Commercial |
$515.52
|
| Rate for Payer: United Healthcare All Payer |
$472.56
|
|
|
ACUTE ABDOMEN EXAM(T
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
320T0120
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$69.81 |
| Max. Negotiated Rate |
$515.52 |
| Rate for Payer: Aetna Commercial |
$413.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.86
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cigna Commercial |
$445.71
|
| Rate for Payer: First Health Commercial |
$510.15
|
| Rate for Payer: Humana Commercial |
$456.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$472.56
|
| Rate for Payer: Ohio Health Group HMO |
$402.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.47
|
| Rate for Payer: PHCS Commercial |
$515.52
|
| Rate for Payer: United Healthcare All Payer |
$472.56
|
|
