|
BSS (BALANCED SALT SOLN) 15ML
|
Facility
|
OP
|
$25.26
|
|
|
Service Code
|
NDC 65079515
|
| Hospital Charge Code |
25002909
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Aetna Commercial |
$19.45
|
| Rate for Payer: Anthem Medicaid |
$8.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.70
|
| Rate for Payer: Cash Price |
$12.63
|
| Rate for Payer: Cigna Commercial |
$20.97
|
| Rate for Payer: First Health Commercial |
$24.00
|
| Rate for Payer: Humana Commercial |
$21.47
|
| Rate for Payer: Humana KY Medicaid |
$8.69
|
| Rate for Payer: Kentucky WC Medicaid |
$8.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.23
|
| Rate for Payer: Ohio Health Group HMO |
$18.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.83
|
| Rate for Payer: PHCS Commercial |
$24.25
|
| Rate for Payer: United Healthcare All Payer |
$22.23
|
|
|
BSS PLUS (BALANCED SALT) 500ML
|
Facility
|
IP
|
$334.49
|
|
|
Service Code
|
NDC 65080050
|
| Hospital Charge Code |
25003804
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.48 |
| Max. Negotiated Rate |
$321.11 |
| Rate for Payer: Aetna Commercial |
$257.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.90
|
| Rate for Payer: Cash Price |
$167.24
|
| Rate for Payer: Cigna Commercial |
$277.63
|
| Rate for Payer: First Health Commercial |
$317.77
|
| Rate for Payer: Humana Commercial |
$284.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.35
|
| Rate for Payer: Ohio Health Group HMO |
$250.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.69
|
| Rate for Payer: PHCS Commercial |
$321.11
|
| Rate for Payer: United Healthcare All Payer |
$294.35
|
|
|
BSS PLUS (BALANCED SALT) 500ML
|
Facility
|
OP
|
$334.49
|
|
|
Service Code
|
NDC 65080050
|
| Hospital Charge Code |
25003804
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.48 |
| Max. Negotiated Rate |
$321.11 |
| Rate for Payer: Aetna Commercial |
$257.56
|
| Rate for Payer: Anthem Medicaid |
$115.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.90
|
| Rate for Payer: Cash Price |
$167.24
|
| Rate for Payer: Cigna Commercial |
$277.63
|
| Rate for Payer: First Health Commercial |
$317.77
|
| Rate for Payer: Humana Commercial |
$284.32
|
| Rate for Payer: Humana KY Medicaid |
$115.03
|
| Rate for Payer: Kentucky WC Medicaid |
$116.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.35
|
| Rate for Payer: Ohio Health Group HMO |
$250.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.69
|
| Rate for Payer: PHCS Commercial |
$321.11
|
| Rate for Payer: United Healthcare All Payer |
$294.35
|
|
|
BTB GRAFT 10MM PLUGS PRESHAPE
|
Facility
|
IP
|
$17,160.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.80 |
| Max. Negotiated Rate |
$16,473.60 |
| Rate for Payer: Aetna Commercial |
$13,213.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,384.80
|
| Rate for Payer: Cash Price |
$8,580.00
|
| Rate for Payer: Cigna Commercial |
$14,242.80
|
| Rate for Payer: First Health Commercial |
$16,302.00
|
| Rate for Payer: Humana Commercial |
$14,586.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,100.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,319.60
|
| Rate for Payer: PHCS Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Payer |
$15,100.80
|
|
|
BTB GRAFT 10MM PLUGS PRESHAPE
|
Facility
|
OP
|
$17,160.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.80 |
| Max. Negotiated Rate |
$16,473.60 |
| Rate for Payer: Aetna Commercial |
$13,213.20
|
| Rate for Payer: Anthem Medicaid |
$5,901.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,384.80
|
| Rate for Payer: Cash Price |
$8,580.00
|
| Rate for Payer: Cigna Commercial |
$14,242.80
|
| Rate for Payer: First Health Commercial |
$16,302.00
|
| Rate for Payer: Humana Commercial |
$14,586.00
|
| Rate for Payer: Humana KY Medicaid |
$5,901.32
|
| Rate for Payer: Kentucky WC Medicaid |
$5,961.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,019.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,100.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,319.60
|
| Rate for Payer: PHCS Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Payer |
$15,100.80
|
|
|
BTB SLECT W/10MM BONE PLUGS
|
Facility
|
IP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
BTB SLECT W/10MM BONE PLUGS
|
Facility
|
OP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem Medicaid |
$4,272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Humana KY Medicaid |
$4,272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,316.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
B-TYPE NATRIURETIC PEPTIDE
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30000454
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.74
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
B-TYPE NATRIURETIC PEPTIDE
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30000454
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem Medicaid |
$39.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$39.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.26
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Humana KY Medicaid |
$39.26
|
| Rate for Payer: Humana Medicare Advantage |
$39.26
|
| Rate for Payer: Kentucky WC Medicaid |
$39.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.74
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
B-TYPE NATRIURETIC PEPTIDE
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30000454
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna Commercial |
$65.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$154.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$29.97
|
| Rate for Payer: Healthspan PPO |
$35.57
|
| Rate for Payer: Multiplan PHCS |
$92.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$107.80
|
| Rate for Payer: UHCCP Medicaid |
$53.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.56
|
|
|
BUMEX(BUMETANIDE)0.25MG/ML 10M
|
Facility
|
IP
|
$79.28
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$76.11 |
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.84
|
| Rate for Payer: Cash Price |
$39.64
|
| Rate for Payer: Cigna Commercial |
$65.80
|
| Rate for Payer: First Health Commercial |
$75.32
|
| Rate for Payer: Humana Commercial |
$67.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.77
|
| Rate for Payer: Ohio Health Group HMO |
$59.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.58
|
| Rate for Payer: PHCS Commercial |
$76.11
|
| Rate for Payer: United Healthcare All Payer |
$69.77
|
|
|
BUMEX(BUMETANIDE)0.25MG/ML 10M
|
Facility
|
OP
|
$79.28
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$76.11 |
| Rate for Payer: Aetna Commercial |
$61.05
|
| Rate for Payer: Anthem Medicaid |
$27.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.84
|
| Rate for Payer: Cash Price |
$39.64
|
| Rate for Payer: Cigna Commercial |
$65.80
|
| Rate for Payer: First Health Commercial |
$75.32
|
| Rate for Payer: Humana Commercial |
$67.39
|
| Rate for Payer: Humana KY Medicaid |
$27.26
|
| Rate for Payer: Kentucky WC Medicaid |
$27.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.77
|
| Rate for Payer: Ohio Health Group HMO |
$59.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.58
|
| Rate for Payer: PHCS Commercial |
$76.11
|
| Rate for Payer: United Healthcare All Payer |
$69.77
|
|
|
BUMEX (BUMETANIDE) 0 .5MG/1TAB
|
Facility
|
IP
|
$4.54
|
|
|
Service Code
|
NDC 832054011
|
| Hospital Charge Code |
25000350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
BUMEX (BUMETANIDE) 0 .5MG/1TAB
|
Facility
|
OP
|
$4.54
|
|
|
Service Code
|
NDC 832054011
|
| Hospital Charge Code |
25000350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
BUMEX(BUMETANIDE) 1MG/ 1MG/4ML
|
Facility
|
IP
|
$79.02
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.86 |
| Rate for Payer: Aetna Commercial |
$60.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.64
|
| Rate for Payer: Cash Price |
$39.51
|
| Rate for Payer: Cigna Commercial |
$65.59
|
| Rate for Payer: First Health Commercial |
$75.07
|
| Rate for Payer: Humana Commercial |
$67.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.54
|
| Rate for Payer: Ohio Health Group HMO |
$59.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.50
|
| Rate for Payer: PHCS Commercial |
$75.86
|
| Rate for Payer: United Healthcare All Payer |
$69.54
|
|
|
BUMEX(BUMETANIDE) 1MG/ 1MG/4ML
|
Facility
|
OP
|
$79.02
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.86 |
| Rate for Payer: Aetna Commercial |
$60.85
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.64
|
| Rate for Payer: Cash Price |
$39.51
|
| Rate for Payer: Cigna Commercial |
$65.59
|
| Rate for Payer: First Health Commercial |
$75.07
|
| Rate for Payer: Humana Commercial |
$67.17
|
| Rate for Payer: Humana KY Medicaid |
$27.17
|
| Rate for Payer: Kentucky WC Medicaid |
$27.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.54
|
| Rate for Payer: Ohio Health Group HMO |
$59.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.50
|
| Rate for Payer: PHCS Commercial |
$75.86
|
| Rate for Payer: United Healthcare All Payer |
$69.54
|
|
|
BUMEX (BUMETANIDE) 1MG/1TAB
|
Facility
|
IP
|
$9.25
|
|
|
Service Code
|
NDC 50268013111
|
| Hospital Charge Code |
25000349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Aetna Commercial |
$7.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.22
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cigna Commercial |
$7.68
|
| Rate for Payer: First Health Commercial |
$8.79
|
| Rate for Payer: Humana Commercial |
$7.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.14
|
| Rate for Payer: Ohio Health Group HMO |
$6.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.87
|
| Rate for Payer: PHCS Commercial |
$8.88
|
| Rate for Payer: United Healthcare All Payer |
$8.14
|
|
|
BUMEX (BUMETANIDE) 1MG/1TAB
|
Facility
|
OP
|
$9.25
|
|
|
Service Code
|
NDC 50268013111
|
| Hospital Charge Code |
25000349
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Aetna Commercial |
$7.12
|
| Rate for Payer: Anthem Medicaid |
$3.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.22
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cigna Commercial |
$7.68
|
| Rate for Payer: First Health Commercial |
$8.79
|
| Rate for Payer: Humana Commercial |
$7.86
|
| Rate for Payer: Humana KY Medicaid |
$3.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.14
|
| Rate for Payer: Ohio Health Group HMO |
$6.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.87
|
| Rate for Payer: PHCS Commercial |
$8.88
|
| Rate for Payer: United Healthcare All Payer |
$8.14
|
|
|
BUN-UREA NITROGEN; QUANT.
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
30000547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$3.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.95
|
| 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 |
$3.95
|
| Rate for Payer: Humana Medicare Advantage |
$3.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3.99
|
| 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 |
$4.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.03
|
| 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
|
|
|
BUN-UREA NITROGEN; QUANT.
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
30000547
|
|
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
|
|
|
BUPIVACAINE 0.25% PF VIAL(10ML
|
Facility
|
OP
|
$75.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$72.08 |
| Rate for Payer: Aetna Commercial |
$57.81
|
| Rate for Payer: Anthem Medicaid |
$25.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cigna Commercial |
$62.32
|
| Rate for Payer: First Health Commercial |
$71.33
|
| Rate for Payer: Humana Commercial |
$63.82
|
| Rate for Payer: Humana KY Medicaid |
$25.82
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$26.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.07
|
| Rate for Payer: Ohio Health Group HMO |
$56.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.27
|
| Rate for Payer: PHCS Commercial |
$72.08
|
| Rate for Payer: United Healthcare All Payer |
$66.07
|
|
|
BUPIVACAINE 0.25% PF VIAL(10ML
|
Professional
|
Both
|
$75.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$75.08 |
| Rate for Payer: Buckeye Medicare Advantage |
$75.08
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Multiplan PHCS |
$45.05
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.56
|
| Rate for Payer: UHCCP Medicaid |
$26.28
|
|
|
BUPIVACAINE 0.25% PF VIAL(10ML
|
Facility
|
OP
|
$75.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$72.08 |
| Rate for Payer: Aetna Commercial |
$57.81
|
| Rate for Payer: Anthem Medicaid |
$25.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cigna Commercial |
$62.32
|
| Rate for Payer: First Health Commercial |
$71.33
|
| Rate for Payer: Humana Commercial |
$63.82
|
| Rate for Payer: Humana KY Medicaid |
$25.82
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$26.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.07
|
| Rate for Payer: Ohio Health Group HMO |
$56.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.27
|
| Rate for Payer: PHCS Commercial |
$72.08
|
| Rate for Payer: United Healthcare All Payer |
$66.07
|
|
|
BUPIVACAINE 0.25% PF VIAL(10ML
|
Facility
|
IP
|
$75.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$72.08 |
| Rate for Payer: Aetna Commercial |
$57.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.56
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cigna Commercial |
$62.32
|
| Rate for Payer: First Health Commercial |
$71.33
|
| Rate for Payer: Humana Commercial |
$63.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.07
|
| Rate for Payer: Ohio Health Group HMO |
$56.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.27
|
| Rate for Payer: PHCS Commercial |
$72.08
|
| Rate for Payer: United Healthcare All Payer |
$66.07
|
|
|
BUPIVACAINE 0.25% PF VIAL(10ML
|
Facility
|
IP
|
$78.29
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$75.16 |
| Rate for Payer: Cigna Commercial |
$64.98
|
| Rate for Payer: First Health Commercial |
$74.38
|
| Rate for Payer: Humana Commercial |
$66.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.90
|
| Rate for Payer: Ohio Health Group HMO |
$58.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.27
|
| Rate for Payer: PHCS Commercial |
$75.16
|
| Rate for Payer: United Healthcare All Payer |
$68.90
|
| Rate for Payer: Aetna Commercial |
$60.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.07
|
| Rate for Payer: Cash Price |
$39.15
|
|
