|
[C]DUAGESIC (FENTAN 100MCG/1EA
|
Facility
|
OP
|
$87.56
|
|
|
Service Code
|
NDC 406900076
|
| Hospital Charge Code |
25000094
|
|
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
|
|
|
[C]DURAGESIC(FENTANY 25MCG/1EA
|
Facility
|
IP
|
$67.13
|
|
|
Service Code
|
NDC 406902576
|
| Hospital Charge Code |
25000095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$64.44 |
| Rate for Payer: Aetna Commercial |
$51.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.36
|
| Rate for Payer: Cash Price |
$33.56
|
| Rate for Payer: Cigna Commercial |
$55.72
|
| Rate for Payer: First Health Commercial |
$63.77
|
| Rate for Payer: Humana Commercial |
$57.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.07
|
| Rate for Payer: Ohio Health Group HMO |
$50.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.81
|
| Rate for Payer: PHCS Commercial |
$64.44
|
| Rate for Payer: United Healthcare All Payer |
$59.07
|
|
|
[C]DURAGESIC(FENTANY 25MCG/1EA
|
Facility
|
OP
|
$67.13
|
|
|
Service Code
|
NDC 406902576
|
| Hospital Charge Code |
25000095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$64.44 |
| Rate for Payer: Aetna Commercial |
$51.69
|
| Rate for Payer: Anthem Medicaid |
$23.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.36
|
| Rate for Payer: Cash Price |
$33.56
|
| Rate for Payer: Cigna Commercial |
$55.72
|
| Rate for Payer: First Health Commercial |
$63.77
|
| Rate for Payer: Humana Commercial |
$57.06
|
| Rate for Payer: Humana KY Medicaid |
$23.09
|
| Rate for Payer: Kentucky WC Medicaid |
$23.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.07
|
| Rate for Payer: Ohio Health Group HMO |
$50.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.81
|
| Rate for Payer: PHCS Commercial |
$64.44
|
| Rate for Payer: United Healthcare All Payer |
$59.07
|
|
|
[C]DURAGESIC(FENTANY 50MCG/1EA
|
Facility
|
OP
|
$72.67
|
|
|
Service Code
|
NDC 406905076
|
| Hospital Charge Code |
25000096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$69.76 |
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Anthem Medicaid |
$24.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.68
|
| Rate for Payer: Cash Price |
$36.34
|
| Rate for Payer: Cigna Commercial |
$60.32
|
| Rate for Payer: First Health Commercial |
$69.04
|
| Rate for Payer: Humana Commercial |
$61.77
|
| Rate for Payer: Humana KY Medicaid |
$24.99
|
| Rate for Payer: Kentucky WC Medicaid |
$25.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.95
|
| Rate for Payer: Ohio Health Group HMO |
$54.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.53
|
| Rate for Payer: PHCS Commercial |
$69.76
|
| Rate for Payer: United Healthcare All Payer |
$63.95
|
|
|
[C]DURAGESIC(FENTANY 50MCG/1EA
|
Facility
|
IP
|
$72.67
|
|
|
Service Code
|
NDC 406905076
|
| Hospital Charge Code |
25000096
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$69.76 |
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.68
|
| Rate for Payer: Cash Price |
$36.34
|
| Rate for Payer: Cigna Commercial |
$60.32
|
| Rate for Payer: First Health Commercial |
$69.04
|
| Rate for Payer: Humana Commercial |
$61.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.95
|
| Rate for Payer: Ohio Health Group HMO |
$54.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.53
|
| Rate for Payer: PHCS Commercial |
$69.76
|
| Rate for Payer: United Healthcare All Payer |
$63.95
|
|
|
[C]DURAGESIC(FENTANY 75MCG/1EA
|
Facility
|
OP
|
$80.02
|
|
|
Service Code
|
NDC 406917576
|
| Hospital Charge Code |
25000097
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$76.82 |
| Rate for Payer: Anthem Medicaid |
$27.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.42
|
| Rate for Payer: Cash Price |
$40.01
|
| Rate for Payer: Cigna Commercial |
$66.42
|
| Rate for Payer: First Health Commercial |
$76.02
|
| Rate for Payer: Humana Commercial |
$68.02
|
| Rate for Payer: Humana KY Medicaid |
$27.52
|
| Rate for Payer: Kentucky WC Medicaid |
$27.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.62
|
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.42
|
| Rate for Payer: Ohio Health Group HMO |
$60.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.81
|
| Rate for Payer: PHCS Commercial |
$76.82
|
| Rate for Payer: United Healthcare All Payer |
$70.42
|
|
|
[C]DURAGESIC(FENTANY 75MCG/1EA
|
Facility
|
IP
|
$80.02
|
|
|
Service Code
|
NDC 406917576
|
| Hospital Charge Code |
25000097
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$76.82 |
| Rate for Payer: Aetna Commercial |
$61.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.42
|
| Rate for Payer: Cash Price |
$40.01
|
| Rate for Payer: Cigna Commercial |
$66.42
|
| Rate for Payer: First Health Commercial |
$76.02
|
| Rate for Payer: Humana Commercial |
$68.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.42
|
| Rate for Payer: Ohio Health Group HMO |
$60.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.81
|
| Rate for Payer: PHCS Commercial |
$76.82
|
| Rate for Payer: United Healthcare All Payer |
$70.42
|
|
|
CEFADROXIL 250mg/5mL 100mLSusp
|
Facility
|
IP
|
$51.43
|
|
|
Service Code
|
NDC 57237009701
|
| Hospital Charge Code |
25004191
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$49.37 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.12
|
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Cigna Commercial |
$42.69
|
| Rate for Payer: First Health Commercial |
$48.86
|
| Rate for Payer: Humana Commercial |
$43.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.26
|
| Rate for Payer: Ohio Health Group HMO |
$38.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.94
|
| Rate for Payer: PHCS Commercial |
$49.37
|
| Rate for Payer: United Healthcare All Payer |
$45.26
|
|
|
CEFADROXIL 250mg/5mL 100mLSusp
|
Facility
|
OP
|
$51.43
|
|
|
Service Code
|
NDC 57237009701
|
| Hospital Charge Code |
25004191
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$49.37 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Anthem Medicaid |
$17.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.12
|
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Cigna Commercial |
$42.69
|
| Rate for Payer: First Health Commercial |
$48.86
|
| Rate for Payer: Humana Commercial |
$43.72
|
| Rate for Payer: Humana KY Medicaid |
$17.69
|
| Rate for Payer: Kentucky WC Medicaid |
$17.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.26
|
| Rate for Payer: Ohio Health Group HMO |
$38.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.94
|
| Rate for Payer: PHCS Commercial |
$49.37
|
| Rate for Payer: United Healthcare All Payer |
$45.26
|
|
|
CEFADROXIL 250MG/5ML 5ML SUSP
|
Facility
|
OP
|
$10.43
|
|
|
Service Code
|
NDC 57237009701
|
| Hospital Charge Code |
25004270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Anthem Medicaid |
$3.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.14
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cigna Commercial |
$8.66
|
| Rate for Payer: First Health Commercial |
$9.91
|
| Rate for Payer: Humana Commercial |
$8.87
|
| Rate for Payer: Humana KY Medicaid |
$3.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.18
|
| Rate for Payer: Ohio Health Group HMO |
$7.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.23
|
| Rate for Payer: PHCS Commercial |
$10.01
|
| Rate for Payer: United Healthcare All Payer |
$9.18
|
|
|
CEFADROXIL 250MG/5ML 5ML SUSP
|
Facility
|
IP
|
$10.43
|
|
|
Service Code
|
NDC 57237009701
|
| Hospital Charge Code |
25004270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.14
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cigna Commercial |
$8.66
|
| Rate for Payer: First Health Commercial |
$9.91
|
| Rate for Payer: Humana Commercial |
$8.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.18
|
| Rate for Payer: Ohio Health Group HMO |
$7.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.23
|
| Rate for Payer: PHCS Commercial |
$10.01
|
| Rate for Payer: United Healthcare All Payer |
$9.18
|
|
|
CEFADROXIL 500mg/5mL 100mLSusp
|
Facility
|
OP
|
$52.37
|
|
|
Service Code
|
NDC 57237009801
|
| Hospital Charge Code |
25004193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$50.28 |
| Rate for Payer: Aetna Commercial |
$40.32
|
| Rate for Payer: Anthem Medicaid |
$18.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.85
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Cigna Commercial |
$43.47
|
| Rate for Payer: First Health Commercial |
$49.75
|
| Rate for Payer: Humana Commercial |
$44.51
|
| Rate for Payer: Humana KY Medicaid |
$18.01
|
| Rate for Payer: Kentucky WC Medicaid |
$18.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.09
|
| Rate for Payer: Ohio Health Group HMO |
$39.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.23
|
| Rate for Payer: PHCS Commercial |
$50.28
|
| Rate for Payer: United Healthcare All Payer |
$46.09
|
|
|
CEFADROXIL 500mg/5mL 100mLSusp
|
Facility
|
IP
|
$52.37
|
|
|
Service Code
|
NDC 57237009801
|
| Hospital Charge Code |
25004193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$50.28 |
| Rate for Payer: Aetna Commercial |
$40.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.85
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Cigna Commercial |
$43.47
|
| Rate for Payer: First Health Commercial |
$49.75
|
| Rate for Payer: Humana Commercial |
$44.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.09
|
| Rate for Payer: Ohio Health Group HMO |
$39.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.23
|
| Rate for Payer: PHCS Commercial |
$50.28
|
| Rate for Payer: United Healthcare All Payer |
$46.09
|
|
|
CEFADROXIL 500mg/5mL 75mL Susp
|
Facility
|
OP
|
$52.37
|
|
|
Service Code
|
NDC 57237009875
|
| Hospital Charge Code |
25004192
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$50.28 |
| Rate for Payer: Aetna Commercial |
$40.32
|
| Rate for Payer: Anthem Medicaid |
$18.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.85
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Cigna Commercial |
$43.47
|
| Rate for Payer: First Health Commercial |
$49.75
|
| Rate for Payer: Humana Commercial |
$44.51
|
| Rate for Payer: Humana KY Medicaid |
$18.01
|
| Rate for Payer: Kentucky WC Medicaid |
$18.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.09
|
| Rate for Payer: Ohio Health Group HMO |
$39.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.23
|
| Rate for Payer: PHCS Commercial |
$50.28
|
| Rate for Payer: United Healthcare All Payer |
$46.09
|
|
|
CEFADROXIL 500mg/5mL 75mL Susp
|
Facility
|
IP
|
$52.37
|
|
|
Service Code
|
NDC 57237009875
|
| Hospital Charge Code |
25004192
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$50.28 |
| Rate for Payer: Aetna Commercial |
$40.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.85
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Cigna Commercial |
$43.47
|
| Rate for Payer: First Health Commercial |
$49.75
|
| Rate for Payer: Humana Commercial |
$44.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.09
|
| Rate for Payer: Ohio Health Group HMO |
$39.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.23
|
| Rate for Payer: PHCS Commercial |
$50.28
|
| Rate for Payer: United Healthcare All Payer |
$46.09
|
|
|
CEFADROXIL 500mg CAPSULE
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.25
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cigna Commercial |
$2.40
|
| Rate for Payer: First Health Commercial |
$2.75
|
| Rate for Payer: Humana Commercial |
$2.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.54
|
| Rate for Payer: Ohio Health Group HMO |
$2.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.90
|
| Rate for Payer: PHCS Commercial |
$2.77
|
| Rate for Payer: United Healthcare All Payer |
$2.54
|
|
|
CEFADROXIL 500mg CAPSULE
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Anthem Medicaid |
$0.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.25
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cigna Commercial |
$2.40
|
| Rate for Payer: First Health Commercial |
$2.75
|
| Rate for Payer: Humana Commercial |
$2.46
|
| Rate for Payer: Humana KY Medicaid |
$0.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.54
|
| Rate for Payer: Ohio Health Group HMO |
$2.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.90
|
| Rate for Payer: PHCS Commercial |
$2.77
|
| Rate for Payer: United Healthcare All Payer |
$2.54
|
|
|
CEFAZOLIN 1GM (AIC) VIAL
|
Facility
|
IP
|
$77.43
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$74.33 |
| Rate for Payer: Aetna Commercial |
$59.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.40
|
| Rate for Payer: Cash Price |
$38.72
|
| Rate for Payer: Cigna Commercial |
$64.27
|
| Rate for Payer: First Health Commercial |
$73.56
|
| Rate for Payer: Humana Commercial |
$65.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.14
|
| Rate for Payer: Ohio Health Group HMO |
$58.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.00
|
| Rate for Payer: PHCS Commercial |
$74.33
|
| Rate for Payer: United Healthcare All Payer |
$68.14
|
|
|
CEFAZOLIN 1GM (AIC) VIAL
|
Facility
|
OP
|
$77.43
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$74.33 |
| Rate for Payer: Aetna Commercial |
$59.62
|
| Rate for Payer: Anthem Medicaid |
$26.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.40
|
| Rate for Payer: Cash Price |
$38.72
|
| Rate for Payer: Cigna Commercial |
$64.27
|
| Rate for Payer: First Health Commercial |
$73.56
|
| Rate for Payer: Humana Commercial |
$65.82
|
| Rate for Payer: Humana KY Medicaid |
$26.63
|
| Rate for Payer: Kentucky WC Medicaid |
$26.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.14
|
| Rate for Payer: Ohio Health Group HMO |
$58.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.00
|
| Rate for Payer: PHCS Commercial |
$74.33
|
| Rate for Payer: United Healthcare All Payer |
$68.14
|
|
|
CEFOTAXIME SODIUM 1 GRAM
|
Facility
|
IP
|
$112.03
|
|
|
Service Code
|
HCPCS J0698
|
| Hospital Charge Code |
25001951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$107.55 |
| Rate for Payer: Aetna Commercial |
$86.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.38
|
| Rate for Payer: Cash Price |
$56.02
|
| Rate for Payer: Cigna Commercial |
$92.98
|
| Rate for Payer: First Health Commercial |
$106.43
|
| Rate for Payer: Humana Commercial |
$95.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.59
|
| Rate for Payer: Ohio Health Group HMO |
$84.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.73
|
| Rate for Payer: PHCS Commercial |
$107.55
|
| Rate for Payer: United Healthcare All Payer |
$98.59
|
|
|
CEFOTAXIME SODIUM 1 GRAM
|
Facility
|
OP
|
$112.03
|
|
|
Service Code
|
HCPCS J0698
|
| Hospital Charge Code |
25001951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$107.55 |
| Rate for Payer: Anthem Medicaid |
$38.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.38
|
| Rate for Payer: Cash Price |
$56.02
|
| Rate for Payer: Cigna Commercial |
$92.98
|
| Rate for Payer: First Health Commercial |
$106.43
|
| Rate for Payer: Humana Commercial |
$95.23
|
| Rate for Payer: Humana KY Medicaid |
$38.53
|
| Rate for Payer: Kentucky WC Medicaid |
$38.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.59
|
| Rate for Payer: Ohio Health Group HMO |
$84.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.73
|
| Rate for Payer: PHCS Commercial |
$107.55
|
| Rate for Payer: United Healthcare All Payer |
$98.59
|
| Rate for Payer: Aetna Commercial |
$86.26
|
|
|
CEFTAZIDIME 500MG (1GM) PEDS
|
Facility
|
IP
|
$24.53
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
25004238
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$23.55 |
| Rate for Payer: Aetna Commercial |
$18.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.13
|
| Rate for Payer: Cash Price |
$12.27
|
| Rate for Payer: Cigna Commercial |
$20.36
|
| Rate for Payer: First Health Commercial |
$23.30
|
| Rate for Payer: Humana Commercial |
$20.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.59
|
| Rate for Payer: Ohio Health Group HMO |
$18.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.60
|
| Rate for Payer: PHCS Commercial |
$23.55
|
| Rate for Payer: United Healthcare All Payer |
$21.59
|
|
|
CEFTAZIDIME 500MG (1GM) PEDS
|
Facility
|
OP
|
$24.53
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
25004238
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$23.55 |
| Rate for Payer: Aetna Commercial |
$18.89
|
| Rate for Payer: Anthem Medicaid |
$8.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.13
|
| Rate for Payer: Cash Price |
$12.27
|
| Rate for Payer: Cigna Commercial |
$20.36
|
| Rate for Payer: First Health Commercial |
$23.30
|
| Rate for Payer: Humana Commercial |
$20.85
|
| Rate for Payer: Humana KY Medicaid |
$8.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.59
|
| Rate for Payer: Ohio Health Group HMO |
$18.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.60
|
| Rate for Payer: PHCS Commercial |
$23.55
|
| Rate for Payer: United Healthcare All Payer |
$21.59
|
|
|
CELEBREX (CELECOXIB) 100MG TAB
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
NDC 72241002305
|
| Hospital Charge Code |
25000400
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Humana Commercial |
$3.63
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.76
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Payer |
$3.76
|
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.06
|
|
|
CELEBREX (CELECOXIB) 100MG TAB
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
NDC 72241002305
|
| Hospital Charge Code |
25000400
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.06
|
| Rate for Payer: Humana Commercial |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.76
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Payer |
$3.76
|
|
