|
BUPIVACAINE 0.25% PF VIAL(10ML
|
Facility
|
IP
|
$75.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600112
|
|
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
|
OP
|
$78.29
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$75.16 |
| Rate for Payer: Aetna Commercial |
$60.28
|
| Rate for Payer: Anthem Medicaid |
$26.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| 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: Humana KY Medicaid |
$26.92
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$27.20
|
| 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 |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.46
|
| 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
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
OP
|
$75.45
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$72.43 |
| Rate for Payer: Aetna Commercial |
$58.10
|
| Rate for Payer: Anthem Medicaid |
$25.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna Commercial |
$62.62
|
| Rate for Payer: First Health Commercial |
$71.68
|
| Rate for Payer: Humana Commercial |
$64.13
|
| Rate for Payer: Humana KY Medicaid |
$25.95
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$26.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.40
|
| Rate for Payer: Ohio Health Group HMO |
$56.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.39
|
| Rate for Payer: PHCS Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Payer |
$66.40
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Professional
|
Both
|
$75.45
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$75.45 |
| Rate for Payer: Buckeye Medicare Advantage |
$75.45
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Multiplan PHCS |
$45.27
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.82
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
OP
|
$75.45
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$72.43 |
| Rate for Payer: Aetna Commercial |
$58.10
|
| Rate for Payer: Anthem Medicaid |
$25.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna Commercial |
$62.62
|
| Rate for Payer: First Health Commercial |
$71.68
|
| Rate for Payer: Humana Commercial |
$64.13
|
| Rate for Payer: Humana KY Medicaid |
$25.95
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$26.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.40
|
| Rate for Payer: Ohio Health Group HMO |
$56.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.39
|
| Rate for Payer: PHCS Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Payer |
$66.40
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25004233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$75.31 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: Anthem Medicaid |
$26.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$39.23
|
| Rate for Payer: Cash Price |
$39.23
|
| Rate for Payer: Cigna Commercial |
$65.11
|
| Rate for Payer: First Health Commercial |
$74.53
|
| Rate for Payer: Humana Commercial |
$66.68
|
| Rate for Payer: Humana KY Medicaid |
$26.98
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$27.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.04
|
| Rate for Payer: Ohio Health Group HMO |
$58.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.32
|
| Rate for Payer: PHCS Commercial |
$75.31
|
| Rate for Payer: United Healthcare All Payer |
$69.04
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25004233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$75.31 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.19
|
| Rate for Payer: Cash Price |
$39.23
|
| Rate for Payer: Cigna Commercial |
$65.11
|
| Rate for Payer: First Health Commercial |
$74.53
|
| Rate for Payer: Humana Commercial |
$66.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.04
|
| Rate for Payer: Ohio Health Group HMO |
$58.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.32
|
| Rate for Payer: PHCS Commercial |
$75.31
|
| Rate for Payer: United Healthcare All Payer |
$69.04
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
IP
|
$75.45
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$72.43 |
| Rate for Payer: Aetna Commercial |
$58.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.85
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna Commercial |
$62.62
|
| Rate for Payer: First Health Commercial |
$71.68
|
| Rate for Payer: Humana Commercial |
$64.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.40
|
| Rate for Payer: Ohio Health Group HMO |
$56.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.39
|
| Rate for Payer: PHCS Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Payer |
$66.40
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
IP
|
$75.45
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$72.43 |
| Rate for Payer: Aetna Commercial |
$58.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.85
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cigna Commercial |
$62.62
|
| Rate for Payer: First Health Commercial |
$71.68
|
| Rate for Payer: Humana Commercial |
$64.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.40
|
| Rate for Payer: Ohio Health Group HMO |
$56.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.39
|
| Rate for Payer: PHCS Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Payer |
$66.40
|
|
|
BUPIVACAINE 0.5% PF 10ML VIAL
|
Professional
|
Both
|
$74.89
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$74.89 |
| Rate for Payer: Buckeye Medicare Advantage |
$74.89
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Multiplan PHCS |
$44.93
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.42
|
| Rate for Payer: UHCCP Medicaid |
$26.21
|
|
|
BUPIVACAINE 0.5% PF 10ML VIAL
|
Facility
|
OP
|
$74.89
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$71.89 |
| Rate for Payer: Aetna Commercial |
$57.67
|
| Rate for Payer: Anthem Medicaid |
$25.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cigna Commercial |
$62.16
|
| Rate for Payer: First Health Commercial |
$71.15
|
| Rate for Payer: Humana Commercial |
$63.66
|
| Rate for Payer: Humana KY Medicaid |
$25.75
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$26.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.90
|
| Rate for Payer: Ohio Health Group HMO |
$56.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.22
|
| Rate for Payer: PHCS Commercial |
$71.89
|
| Rate for Payer: United Healthcare All Payer |
$65.90
|
|
|
BUPIVACAINE 0.5% PF 10ML VIAL
|
Facility
|
IP
|
$74.89
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$71.89 |
| Rate for Payer: Aetna Commercial |
$57.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.41
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cigna Commercial |
$62.16
|
| Rate for Payer: First Health Commercial |
$71.15
|
| Rate for Payer: Humana Commercial |
$63.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.90
|
| Rate for Payer: Ohio Health Group HMO |
$56.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.22
|
| Rate for Payer: PHCS Commercial |
$71.89
|
| Rate for Payer: United Healthcare All Payer |
$65.90
|
|
|
BUPIVACAINE 0.5% PF 10ML VIAL
|
Facility
|
OP
|
$74.89
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$71.89 |
| Rate for Payer: Aetna Commercial |
$57.67
|
| Rate for Payer: Anthem Medicaid |
$25.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cigna Commercial |
$62.16
|
| Rate for Payer: First Health Commercial |
$71.15
|
| Rate for Payer: Humana Commercial |
$63.66
|
| Rate for Payer: Humana KY Medicaid |
$25.75
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$26.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.90
|
| Rate for Payer: Ohio Health Group HMO |
$56.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.22
|
| Rate for Payer: PHCS Commercial |
$71.89
|
| Rate for Payer: United Healthcare All Payer |
$65.90
|
|
|
BUPIVACAINE 0.5% PF 10ML VIAL
|
Facility
|
IP
|
$74.89
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$71.89 |
| Rate for Payer: Aetna Commercial |
$57.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.41
|
| Rate for Payer: Cash Price |
$37.44
|
| Rate for Payer: Cigna Commercial |
$62.16
|
| Rate for Payer: First Health Commercial |
$71.15
|
| Rate for Payer: Humana Commercial |
$63.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.90
|
| Rate for Payer: Ohio Health Group HMO |
$56.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.22
|
| Rate for Payer: PHCS Commercial |
$71.89
|
| Rate for Payer: United Healthcare All Payer |
$65.90
|
|
|
BUPIVACAINE 0.5% PF 10ML VIAL
|
Facility
|
OP
|
$77.89
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25002912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$74.77 |
| Rate for Payer: Aetna Commercial |
$59.98
|
| Rate for Payer: Anthem Medicaid |
$26.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cigna Commercial |
$64.65
|
| Rate for Payer: First Health Commercial |
$74.00
|
| Rate for Payer: Humana Commercial |
$66.21
|
| Rate for Payer: Humana KY Medicaid |
$26.79
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$27.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.54
|
| Rate for Payer: Ohio Health Group HMO |
$58.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$74.77
|
| Rate for Payer: United Healthcare All Payer |
$68.54
|
|
|
BUPIVACAINE 0.5% PF 10ML VIAL
|
Facility
|
IP
|
$77.89
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25002912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$74.77 |
| Rate for Payer: Aetna Commercial |
$59.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.75
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cigna Commercial |
$64.65
|
| Rate for Payer: First Health Commercial |
$74.00
|
| Rate for Payer: Humana Commercial |
$66.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.54
|
| Rate for Payer: Ohio Health Group HMO |
$58.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$74.77
|
| Rate for Payer: United Healthcare All Payer |
$68.54
|
|
|
BUPIVACAINE 0.75% 10ML SDV
|
Facility
|
OP
|
$107.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$102.80 |
| Rate for Payer: Aetna Commercial |
$82.45
|
| Rate for Payer: Anthem Medicaid |
$36.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$53.54
|
| Rate for Payer: Cash Price |
$53.54
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: First Health Commercial |
$101.73
|
| Rate for Payer: Humana Commercial |
$91.02
|
| Rate for Payer: Humana KY Medicaid |
$36.82
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$37.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.23
|
| Rate for Payer: Ohio Health Group HMO |
$80.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.19
|
| Rate for Payer: PHCS Commercial |
$102.80
|
| Rate for Payer: United Healthcare All Payer |
$94.23
|
|
|
BUPIVACAINE 0.75% 10ML SDV
|
Facility
|
OP
|
$112.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25004241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$107.60 |
| Rate for Payer: Aetna Commercial |
$86.30
|
| Rate for Payer: Anthem Medicaid |
$38.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$56.04
|
| Rate for Payer: Cash Price |
$56.04
|
| Rate for Payer: Cigna Commercial |
$93.03
|
| Rate for Payer: First Health Commercial |
$106.48
|
| Rate for Payer: Humana Commercial |
$95.27
|
| Rate for Payer: Humana KY Medicaid |
$38.54
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$38.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.63
|
| Rate for Payer: Ohio Health Group HMO |
$84.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.74
|
| Rate for Payer: PHCS Commercial |
$107.60
|
| Rate for Payer: United Healthcare All Payer |
$98.63
|
|
|
BUPIVACAINE 0.75% 10ML SDV
|
Facility
|
IP
|
$107.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$102.80 |
| Rate for Payer: Aetna Commercial |
$82.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.52
|
| Rate for Payer: Cash Price |
$53.54
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: First Health Commercial |
$101.73
|
| Rate for Payer: Humana Commercial |
$91.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.23
|
| Rate for Payer: Ohio Health Group HMO |
$80.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.19
|
| Rate for Payer: PHCS Commercial |
$102.80
|
| Rate for Payer: United Healthcare All Payer |
$94.23
|
|
|
BUPIVACAINE 0.75% 10ML SDV
|
Facility
|
OP
|
$107.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$102.80 |
| Rate for Payer: Aetna Commercial |
$82.45
|
| Rate for Payer: Anthem Medicaid |
$36.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$53.54
|
| Rate for Payer: Cash Price |
$53.54
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: First Health Commercial |
$101.73
|
| Rate for Payer: Humana Commercial |
$91.02
|
| Rate for Payer: Humana KY Medicaid |
$36.82
|
| Rate for Payer: Humana Medicare Advantage |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$37.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.23
|
| Rate for Payer: Ohio Health Group HMO |
$80.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.19
|
| Rate for Payer: PHCS Commercial |
$102.80
|
| Rate for Payer: United Healthcare All Payer |
$94.23
|
|
|
BUPIVACAINE 0.75% 10ML SDV
|
Facility
|
IP
|
$107.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$102.80 |
| Rate for Payer: Aetna Commercial |
$82.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.52
|
| Rate for Payer: Cash Price |
$53.54
|
| Rate for Payer: Cigna Commercial |
$88.88
|
| Rate for Payer: First Health Commercial |
$101.73
|
| Rate for Payer: Humana Commercial |
$91.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.23
|
| Rate for Payer: Ohio Health Group HMO |
$80.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.19
|
| Rate for Payer: PHCS Commercial |
$102.80
|
| Rate for Payer: United Healthcare All Payer |
$94.23
|
|
|
BUPIVACAINE 0.75% 10ML SDV
|
Professional
|
Both
|
$107.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.48 |
| Max. Negotiated Rate |
$107.08 |
| Rate for Payer: Buckeye Medicare Advantage |
$107.08
|
| Rate for Payer: Cash Price |
$53.54
|
| Rate for Payer: Multiplan PHCS |
$64.25
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.96
|
| Rate for Payer: UHCCP Medicaid |
$37.48
|
|
|
BUPIVACAINE 0.75% 10ML SDV
|
Facility
|
IP
|
$112.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25004241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$107.60 |
| Rate for Payer: Aetna Commercial |
$86.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.42
|
| Rate for Payer: Cash Price |
$56.04
|
| Rate for Payer: Cigna Commercial |
$93.03
|
| Rate for Payer: First Health Commercial |
$106.48
|
| Rate for Payer: Humana Commercial |
$95.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.63
|
| Rate for Payer: Ohio Health Group HMO |
$84.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.74
|
| Rate for Payer: PHCS Commercial |
$107.60
|
| Rate for Payer: United Healthcare All Payer |
$98.63
|
|
|
BURCH PROCEDURE
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 51840
|
| Hospital Charge Code |
76102073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.89 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,044.04
|
| Rate for Payer: Anthem Medicaid |
$564.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$969.22
|
| Rate for Payer: Healthspan PPO |
$834.80
|
| Rate for Payer: Humana Medicaid |
$564.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$893.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$576.19
|
| Rate for Payer: Molina Healthcare Passport |
$564.89
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$570.54
|
|
|
BURCH PROCEDURE
|
Professional
|
Both
|
$8,631.00
|
|
|
Service Code
|
HCPCS 51845
|
| Hospital Charge Code |
76102075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$579.60 |
| Max. Negotiated Rate |
$8,631.00 |
| Rate for Payer: Aetna Commercial |
$944.80
|
| Rate for Payer: Anthem Medicaid |
$579.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,631.00
|
| Rate for Payer: Cash Price |
$4,315.50
|
| Rate for Payer: Cash Price |
$4,315.50
|
| Rate for Payer: Cigna Commercial |
$857.58
|
| Rate for Payer: Healthspan PPO |
$755.46
|
| Rate for Payer: Humana Medicaid |
$579.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$802.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$591.19
|
| Rate for Payer: Molina Healthcare Passport |
$579.60
|
| Rate for Payer: Multiplan PHCS |
$5,178.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,041.70
|
| Rate for Payer: UHCCP Medicaid |
$3,020.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$585.40
|
|
