|
CELEBREX (CELECOXIB)200 MG CAP
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 72241002405
|
| Hospital Charge Code |
25000401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
CELEBREX (CELECOXIB)200 MG CAP
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 72241002405
|
| Hospital Charge Code |
25000401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
CELESTONE 6MG (30MG VIAL)
|
Facility
|
OP
|
$324.03
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
25001953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$311.07 |
| Rate for Payer: Aetna Commercial |
$249.50
|
| Rate for Payer: Anthem Medicaid |
$111.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.74
|
| Rate for Payer: Cash Price |
$162.01
|
| Rate for Payer: Cigna Commercial |
$268.94
|
| Rate for Payer: First Health Commercial |
$307.83
|
| Rate for Payer: Humana Commercial |
$275.43
|
| Rate for Payer: Humana KY Medicaid |
$111.43
|
| Rate for Payer: Kentucky WC Medicaid |
$112.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$285.15
|
| Rate for Payer: Ohio Health Group HMO |
$243.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.45
|
| Rate for Payer: PHCS Commercial |
$311.07
|
| Rate for Payer: United Healthcare All Payer |
$285.15
|
|
|
CELESTONE 6MG (30MG VIAL)
|
Facility
|
IP
|
$63.08
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
63600023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$60.56 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.20
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: First Health Commercial |
$59.93
|
| Rate for Payer: Humana Commercial |
$53.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.51
|
| Rate for Payer: Ohio Health Group HMO |
$47.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.55
|
| Rate for Payer: PHCS Commercial |
$60.56
|
| Rate for Payer: United Healthcare All Payer |
$55.51
|
|
|
CELESTONE 6MG (30MG VIAL)
|
Facility
|
IP
|
$63.08
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
636T0023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$60.56 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.20
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: First Health Commercial |
$59.93
|
| Rate for Payer: Humana Commercial |
$53.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.51
|
| Rate for Payer: Ohio Health Group HMO |
$47.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.55
|
| Rate for Payer: PHCS Commercial |
$60.56
|
| Rate for Payer: United Healthcare All Payer |
$55.51
|
|
|
CELESTONE 6MG (30MG VIAL)
|
Facility
|
OP
|
$63.08
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
63600023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$60.56 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Anthem Medicaid |
$21.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.20
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: First Health Commercial |
$59.93
|
| Rate for Payer: Humana Commercial |
$53.62
|
| Rate for Payer: Humana KY Medicaid |
$21.69
|
| Rate for Payer: Kentucky WC Medicaid |
$21.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.51
|
| Rate for Payer: Ohio Health Group HMO |
$47.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.55
|
| Rate for Payer: PHCS Commercial |
$60.56
|
| Rate for Payer: United Healthcare All Payer |
$55.51
|
|
|
CELESTONE 6MG (30MG VIAL)
|
Facility
|
OP
|
$63.08
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
636T0023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$60.56 |
| Rate for Payer: Aetna Commercial |
$48.57
|
| Rate for Payer: Anthem Medicaid |
$21.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.20
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: First Health Commercial |
$59.93
|
| Rate for Payer: Humana Commercial |
$53.62
|
| Rate for Payer: Humana KY Medicaid |
$21.69
|
| Rate for Payer: Kentucky WC Medicaid |
$21.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.51
|
| Rate for Payer: Ohio Health Group HMO |
$47.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.55
|
| Rate for Payer: PHCS Commercial |
$60.56
|
| Rate for Payer: United Healthcare All Payer |
$55.51
|
|
|
CELESTONE 6MG (30MG VIAL)
|
Facility
|
IP
|
$324.03
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
25001953
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$311.07 |
| Rate for Payer: Aetna Commercial |
$249.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.74
|
| Rate for Payer: Cash Price |
$162.01
|
| Rate for Payer: Cigna Commercial |
$268.94
|
| Rate for Payer: First Health Commercial |
$307.83
|
| Rate for Payer: Humana Commercial |
$275.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$285.15
|
| Rate for Payer: Ohio Health Group HMO |
$243.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.45
|
| Rate for Payer: PHCS Commercial |
$311.07
|
| Rate for Payer: United Healthcare All Payer |
$285.15
|
|
|
CELESTONE 6MG (30MG VIAL)
|
Professional
|
Both
|
$63.08
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
63600023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$63.08 |
| Rate for Payer: Aetna Commercial |
$11.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.08
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Healthspan PPO |
$7.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.64
|
| Rate for Payer: Multiplan PHCS |
$37.85
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.16
|
| Rate for Payer: UHCCP Medicaid |
$22.08
|
|
|
CELEXA 10 MG TABLET
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 904608461
|
| Hospital Charge Code |
25000402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| 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 |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
CELEXA 10 MG TABLET
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 904608461
|
| Hospital Charge Code |
25000402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| 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 |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
CELEXA(CITALOPRAM HYDRO)20MG T
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 904608561
|
| Hospital Charge Code |
25000403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| 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 |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
CELEXA(CITALOPRAM HYDRO)20MG T
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 904608561
|
| Hospital Charge Code |
25000403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| 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 |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
CELLCEPT 500 MG TABLET
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
25002504
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
CELLCEPT 500 MG TABLET
|
Facility
|
OP
|
$4.60
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
25002504
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
CELLCEPT(MYCOPHENMOFETIL)250MG
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
25002505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: First Health Commercial |
$4.42
|
| Rate for Payer: Humana Commercial |
$3.95
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.09
|
| Rate for Payer: Ohio Health Group HMO |
$3.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
|
CELLCEPT(MYCOPHENMOFETIL)250MG
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
25002505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: First Health Commercial |
$4.42
|
| Rate for Payer: Humana Commercial |
$3.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.09
|
| Rate for Payer: Ohio Health Group HMO |
$3.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
|
CELLULITIS WITH MCC
|
Facility
|
IP
|
$17,401.08
|
|
|
Service Code
|
MSDRG 602
|
| Min. Negotiated Rate |
$11,807.87 |
| Max. Negotiated Rate |
$17,401.08 |
| Rate for Payer: Anthem Medicaid |
$11,807.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,429.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,401.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,779.61
|
| Rate for Payer: Humana KY Medicaid |
$11,807.87
|
| Rate for Payer: Humana Medicare Advantage |
$12,429.34
|
| Rate for Payer: Kentucky WC Medicaid |
$11,925.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,915.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,044.03
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
|
IP
|
$10,349.39
|
|
|
Service Code
|
MSDRG 603
|
| Min. Negotiated Rate |
$7,022.80 |
| Max. Negotiated Rate |
$10,349.39 |
| Rate for Payer: Anthem Medicaid |
$7,022.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,392.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,349.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,979.77
|
| Rate for Payer: Humana KY Medicaid |
$7,022.80
|
| Rate for Payer: Humana Medicare Advantage |
$7,392.42
|
| Rate for Payer: Kentucky WC Medicaid |
$7,093.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,870.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,163.25
|
|
|
CELOX VASC. HEMOSTATIC PAD
|
Facility
|
IP
|
$462.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
CELOX VASC. HEMOSTATIC PAD
|
Facility
|
OP
|
$462.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem Medicaid |
$159.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Humana KY Medicaid |
$159.05
|
| Rate for Payer: Kentucky WC Medicaid |
$160.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
CELT ACD 5F
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CELT ACD 5F
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CELT ACD 6F
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CELT ACD 6F
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
