|
BRST IMP X-FL SMTH SFTCH 800CC
|
Facility
|
OP
|
$7,927.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.25 |
| Max. Negotiated Rate |
$7,610.40 |
| Rate for Payer: Aetna Commercial |
$6,104.18
|
| Rate for Payer: Anthem Medicaid |
$2,726.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,183.45
|
| Rate for Payer: Cash Price |
$3,963.75
|
| Rate for Payer: Cigna Commercial |
$6,579.82
|
| Rate for Payer: First Health Commercial |
$7,531.12
|
| Rate for Payer: Humana Commercial |
$6,738.38
|
| Rate for Payer: Humana KY Medicaid |
$2,726.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,754.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,500.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,850.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,378.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,780.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,976.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,945.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,342.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,896.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,469.98
|
| Rate for Payer: PHCS Commercial |
$7,610.40
|
| Rate for Payer: United Healthcare All Payer |
$6,976.20
|
|
|
BRST SALINE SIZER RND MOD 275C
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
BRST SALINE SIZER RND MOD 275C
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
BSS (BALANCED SALT SOLN) 15ML
|
Facility
|
OP
|
$25.26
|
|
|
Service Code
|
NDC 65079515
|
| Hospital Charge Code |
25002909
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.58 |
| 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 |
$18.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.43
|
| Rate for Payer: PHCS Commercial |
$24.25
|
| Rate for Payer: United Healthcare All Payer |
$22.23
|
|
|
BSS (BALANCED SALT SOLN) 15ML
|
Facility
|
IP
|
$25.26
|
|
|
Service Code
|
NDC 65079515
|
| Hospital Charge Code |
25002909
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Aetna Commercial |
$19.45
|
| 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: 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: Ohio Health Choice Commercial |
$22.23
|
| Rate for Payer: Ohio Health Group HMO |
$18.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.43
|
| Rate for Payer: PHCS Commercial |
$24.25
|
| Rate for Payer: United Healthcare All Payer |
$22.23
|
|
|
BSS PLUS (BALANCED SALT) 500ML
|
Facility
|
IP
|
$521.47
|
|
|
Service Code
|
NDC 65080050
|
| Hospital Charge Code |
25003804
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$156.44 |
| Max. Negotiated Rate |
$500.61 |
| Rate for Payer: Aetna Commercial |
$401.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.75
|
| Rate for Payer: Cash Price |
$260.74
|
| Rate for Payer: Cigna Commercial |
$432.82
|
| Rate for Payer: First Health Commercial |
$495.40
|
| Rate for Payer: Humana Commercial |
$443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.89
|
| Rate for Payer: Ohio Health Group HMO |
$391.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.81
|
| Rate for Payer: PHCS Commercial |
$500.61
|
| Rate for Payer: United Healthcare All Payer |
$458.89
|
|
|
BSS PLUS (BALANCED SALT) 500ML
|
Facility
|
OP
|
$521.47
|
|
|
Service Code
|
NDC 65080050
|
| Hospital Charge Code |
25003804
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$156.44 |
| Max. Negotiated Rate |
$500.61 |
| Rate for Payer: Aetna Commercial |
$401.53
|
| Rate for Payer: Anthem Medicaid |
$179.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.75
|
| Rate for Payer: Cash Price |
$260.74
|
| Rate for Payer: Cigna Commercial |
$432.82
|
| Rate for Payer: First Health Commercial |
$495.40
|
| Rate for Payer: Humana Commercial |
$443.25
|
| Rate for Payer: Humana KY Medicaid |
$179.33
|
| Rate for Payer: Kentucky WC Medicaid |
$181.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.89
|
| Rate for Payer: Ohio Health Group HMO |
$391.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.81
|
| Rate for Payer: PHCS Commercial |
$500.61
|
| Rate for Payer: United Healthcare All Payer |
$458.89
|
|
|
BTB GRAFT 10MM PLUGS PRESHAPE
|
Facility
|
IP
|
$17,720.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,316.00 |
| Max. Negotiated Rate |
$17,011.20 |
| Rate for Payer: Aetna Commercial |
$13,644.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,821.60
|
| Rate for Payer: Cash Price |
$8,860.00
|
| Rate for Payer: Cigna Commercial |
$14,707.60
|
| Rate for Payer: First Health Commercial |
$16,834.00
|
| Rate for Payer: Humana Commercial |
$15,062.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,530.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,077.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,316.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,593.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,416.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,226.80
|
| Rate for Payer: PHCS Commercial |
$17,011.20
|
| Rate for Payer: United Healthcare All Payer |
$15,593.60
|
|
|
BTB GRAFT 10MM PLUGS PRESHAPE
|
Facility
|
OP
|
$17,720.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,316.00 |
| Max. Negotiated Rate |
$17,011.20 |
| Rate for Payer: Aetna Commercial |
$13,644.40
|
| Rate for Payer: Anthem Medicaid |
$6,093.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,821.60
|
| Rate for Payer: Cash Price |
$8,860.00
|
| Rate for Payer: Cigna Commercial |
$14,707.60
|
| Rate for Payer: First Health Commercial |
$16,834.00
|
| Rate for Payer: Humana Commercial |
$15,062.00
|
| Rate for Payer: Humana KY Medicaid |
$6,093.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,155.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,530.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,077.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,316.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,216.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,593.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,416.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,226.80
|
| Rate for Payer: PHCS Commercial |
$17,011.20
|
| Rate for Payer: United Healthcare All Payer |
$15,593.60
|
|
|
BTB SLECT W/10MM BONE PLUGS
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
BTB SLECT W/10MM BONE PLUGS
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
B-TYPE NATRIURETIC PEPTIDE
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30000454
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$39.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$39.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.26
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| 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 |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.47
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
B-TYPE NATRIURETIC PEPTIDE
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30000454
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$97.80 |
| Rate for Payer: Aetna Commercial |
$65.22
|
| Rate for Payer: Ambetter Exchange |
$39.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$39.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$39.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$47.11
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$29.97
|
| Rate for Payer: Healthspan PPO |
$35.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$39.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.26
|
| Rate for Payer: Multiplan PHCS |
$97.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$51.04
|
| Rate for Payer: UHCCP Medicaid |
$57.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$39.26
|
|
|
B-TYPE NATRIURETIC PEPTIDE
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30000454
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.47
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
BUMEX(BUMETANIDE)0.25MG/ML 10M
|
Facility
|
OP
|
$79.28
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002910
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$23.78 |
| 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 |
$63.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.70
|
| Rate for Payer: PHCS Commercial |
$76.11
|
| Rate for Payer: United Healthcare All Payer |
$69.77
|
|
|
BUMEX(BUMETANIDE)0.25MG/ML 10M
|
Facility
|
IP
|
$79.28
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002910
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$23.78 |
| 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 |
$63.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.70
|
| 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 50268013011
|
| Hospital Charge Code |
25000350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| 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 |
$3.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| 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 50268013011
|
| Hospital Charge Code |
25000350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| 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 |
$3.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| 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
|
890
|
| Min. Negotiated Rate |
$23.71 |
| 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 |
$59.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.52
|
| 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
|
890
|
| Min. Negotiated Rate |
$23.71 |
| 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 |
$59.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.52
|
| 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 |
$2.77 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Aetna Commercial |
$7.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.21
|
| 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 |
$2.77
|
| 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 |
$7.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.38
|
| 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 |
$2.77 |
| 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 |
$7.21
|
| 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 |
$2.77
|
| 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 |
$7.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.38
|
| Rate for Payer: PHCS Commercial |
$8.88
|
| Rate for Payer: United Healthcare All Payer |
$8.14
|
|
|
BUN-UREA NITROGEN; QUANT.
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
30000547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem Medicaid |
$3.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.95
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| 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 |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.09
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
BUN-UREA NITROGEN; QUANT.
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
30000547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.09
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
BUPIVACAINE 0.25% PF VIAL(10ML
|
Facility
|
OP
|
$1.57
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna Commercial |
$1.21
|
| Rate for Payer: Anthem Medicaid |
$0.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.22
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna Commercial |
$1.30
|
| Rate for Payer: First Health Commercial |
$1.49
|
| Rate for Payer: Humana Commercial |
$1.33
|
| Rate for Payer: Humana KY Medicaid |
$0.54
|
| Rate for Payer: Kentucky WC Medicaid |
$0.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.38
|
| Rate for Payer: Ohio Health Group HMO |
$1.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.08
|
| Rate for Payer: PHCS Commercial |
$1.51
|
| Rate for Payer: United Healthcare All Payer |
$1.38
|
|
