|
BUPIVACAINE 0.25% PF VIAL(10ML
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
BUPIVACAINE 0.25% PF VIAL(10ML
|
Professional
|
Both
|
$1.57
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Ambetter Exchange |
$0.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.01
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Multiplan PHCS |
$0.94
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.01
|
| Rate for Payer: UHCCP Medicaid |
$0.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.01
|
|
|
BUPIVACAINE 0.25% PF VIAL(10ML
|
Facility
|
IP
|
$78.29
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.49 |
| Max. Negotiated Rate |
$75.16 |
| Rate for Payer: Aetna Commercial |
$60.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.07
|
| 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: Medical Mutual Of Ohio HMO |
$64.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.90
|
| Rate for Payer: Ohio Health Group HMO |
$58.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.02
|
| Rate for Payer: PHCS Commercial |
$75.16
|
| Rate for Payer: United Healthcare All Payer |
$68.90
|
|
|
BUPIVACAINE 0.25% PF VIAL(10ML
|
Facility
|
OP
|
$1.57
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600112
|
|
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
|
|
|
BUPIVACAINE 0.25% PF VIAL(10ML
|
Facility
|
IP
|
$1.57
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600112
|
|
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 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: 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: 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
|
|
|
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 |
$23.49 |
| Max. Negotiated Rate |
$75.16 |
| Rate for Payer: Aetna Commercial |
$60.28
|
| Rate for Payer: Anthem Medicaid |
$26.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.07
|
| 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: 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 |
$23.49
|
| 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 |
$62.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.02
|
| Rate for Payer: PHCS Commercial |
$75.16
|
| Rate for Payer: United Healthcare All Payer |
$68.90
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Anthem Medicaid |
$0.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna Commercial |
$0.13
|
| Rate for Payer: First Health Commercial |
$0.15
|
| Rate for Payer: Humana Commercial |
$0.14
|
| Rate for Payer: Humana KY Medicaid |
$0.06
|
| Rate for Payer: Kentucky WC Medicaid |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.14
|
| Rate for Payer: Ohio Health Group HMO |
$0.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.11
|
| Rate for Payer: PHCS Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Payer |
$0.14
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna Commercial |
$0.13
|
| Rate for Payer: First Health Commercial |
$0.15
|
| Rate for Payer: Humana Commercial |
$0.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.14
|
| Rate for Payer: Ohio Health Group HMO |
$0.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.11
|
| Rate for Payer: PHCS Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Payer |
$0.14
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna Commercial |
$0.13
|
| Rate for Payer: First Health Commercial |
$0.15
|
| Rate for Payer: Humana Commercial |
$0.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.14
|
| Rate for Payer: Ohio Health Group HMO |
$0.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.11
|
| Rate for Payer: PHCS Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Payer |
$0.14
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Professional
|
Both
|
$0.16
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Ambetter Exchange |
$0.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.01
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Multiplan PHCS |
$0.10
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.01
|
| Rate for Payer: UHCCP Medicaid |
$0.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.01
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Anthem Medicaid |
$0.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.12
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Cigna Commercial |
$0.13
|
| Rate for Payer: First Health Commercial |
$0.15
|
| Rate for Payer: Humana Commercial |
$0.14
|
| Rate for Payer: Humana KY Medicaid |
$0.06
|
| Rate for Payer: Kentucky WC Medicaid |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.14
|
| Rate for Payer: Ohio Health Group HMO |
$0.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.11
|
| Rate for Payer: PHCS Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Payer |
$0.14
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25004233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.54 |
| 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 |
$62.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.13
|
| Rate for Payer: PHCS Commercial |
$75.31
|
| Rate for Payer: United Healthcare All Payer |
$69.04
|
|
|
BUPIVACAINE 0.5% 50ML MDV
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25004233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.54 |
| Max. Negotiated Rate |
$75.31 |
| Rate for Payer: Aetna Commercial |
$60.41
|
| Rate for Payer: Anthem Medicaid |
$26.98
|
| 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: Humana KY Medicaid |
$26.98
|
| 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 |
$23.54
|
| 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 |
$62.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.13
|
| Rate for Payer: PHCS Commercial |
$75.31
|
| Rate for Payer: United Healthcare All Payer |
$69.04
|
|
|
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 |
$23.37 |
| Max. Negotiated Rate |
$74.77 |
| Rate for Payer: Aetna Commercial |
$59.98
|
| Rate for Payer: Anthem Medicaid |
$26.79
|
| 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: Humana KY Medicaid |
$26.79
|
| 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 |
$23.37
|
| 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 |
$62.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.74
|
| 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 |
$23.37 |
| 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 |
$62.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.74
|
| Rate for Payer: PHCS Commercial |
$74.77
|
| Rate for Payer: United Healthcare All Payer |
$68.54
|
|
|
BUPIVACAINE 0.5% PF 10ML VIAL
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Anthem Medicaid |
$0.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.61
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna Commercial |
$0.65
|
| Rate for Payer: First Health Commercial |
$0.74
|
| Rate for Payer: Humana Commercial |
$0.66
|
| Rate for Payer: Humana KY Medicaid |
$0.27
|
| Rate for Payer: Kentucky WC Medicaid |
$0.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.69
|
| Rate for Payer: Ohio Health Group HMO |
$0.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.54
|
| Rate for Payer: PHCS Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Payer |
$0.69
|
|
|
BUPIVACAINE 0.5% PF 10ML VIAL
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.61
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna Commercial |
$0.65
|
| Rate for Payer: First Health Commercial |
$0.74
|
| Rate for Payer: Humana Commercial |
$0.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.69
|
| Rate for Payer: Ohio Health Group HMO |
$0.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.54
|
| Rate for Payer: PHCS Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Payer |
$0.69
|
|
|
BUPIVACAINE 0.5% PF 10ML VIAL
|
Professional
|
Both
|
$0.78
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Ambetter Exchange |
$0.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.01
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Multiplan PHCS |
$0.47
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.01
|
| Rate for Payer: UHCCP Medicaid |
$0.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.01
|
|
|
BUPIVACAINE 0.5% PF 10ML VIAL
|
Facility
|
IP
|
$0.78
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.61
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna Commercial |
$0.65
|
| Rate for Payer: First Health Commercial |
$0.74
|
| Rate for Payer: Humana Commercial |
$0.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.69
|
| Rate for Payer: Ohio Health Group HMO |
$0.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.54
|
| Rate for Payer: PHCS Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Payer |
$0.69
|
|
|
BUPIVACAINE 0.5% PF 10ML VIAL
|
Facility
|
OP
|
$0.78
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Anthem Medicaid |
$0.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.61
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna Commercial |
$0.65
|
| Rate for Payer: First Health Commercial |
$0.74
|
| Rate for Payer: Humana Commercial |
$0.66
|
| Rate for Payer: Humana KY Medicaid |
$0.27
|
| Rate for Payer: Kentucky WC Medicaid |
$0.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.69
|
| Rate for Payer: Ohio Health Group HMO |
$0.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.54
|
| Rate for Payer: PHCS Commercial |
$0.75
|
| Rate for Payer: United Healthcare All Payer |
$0.69
|
|
|
BUPIVACAINE 0.75% 10ML SDV
|
Facility
|
IP
|
$112.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25004241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.62 |
| 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 |
$89.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.34
|
| Rate for Payer: PHCS Commercial |
$107.60
|
| Rate for Payer: United Healthcare All Payer |
$98.63
|
|
|
BUPIVACAINE 0.75% 10ML SDV
|
Facility
|
IP
|
$0.75
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna Commercial |
$0.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.59
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna Commercial |
$0.62
|
| Rate for Payer: First Health Commercial |
$0.71
|
| Rate for Payer: Humana Commercial |
$0.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.66
|
| Rate for Payer: Ohio Health Group HMO |
$0.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.52
|
| Rate for Payer: PHCS Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Payer |
$0.66
|
|
|
BUPIVACAINE 0.75% 10ML SDV
|
Facility
|
OP
|
$112.08
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25004241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.62 |
| Max. Negotiated Rate |
$107.60 |
| Rate for Payer: Aetna Commercial |
$86.30
|
| Rate for Payer: Anthem Medicaid |
$38.54
|
| 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: Humana KY Medicaid |
$38.54
|
| 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 |
$33.62
|
| 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 |
$89.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.34
|
| Rate for Payer: PHCS Commercial |
$107.60
|
| Rate for Payer: United Healthcare All Payer |
$98.63
|
|
|
BUPIVACAINE 0.75% 10ML SDV
|
Facility
|
OP
|
$0.75
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
636T0165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna Commercial |
$0.58
|
| Rate for Payer: Anthem Medicaid |
$0.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.59
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna Commercial |
$0.62
|
| Rate for Payer: First Health Commercial |
$0.71
|
| Rate for Payer: Humana Commercial |
$0.64
|
| Rate for Payer: Humana KY Medicaid |
$0.26
|
| Rate for Payer: Kentucky WC Medicaid |
$0.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.66
|
| Rate for Payer: Ohio Health Group HMO |
$0.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.52
|
| Rate for Payer: PHCS Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Payer |
$0.66
|
|
|
BUPIVACAINE 0.75% 10ML SDV
|
Facility
|
OP
|
$0.75
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna Commercial |
$0.58
|
| Rate for Payer: Anthem Medicaid |
$0.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.59
|
| Rate for Payer: Cash Price |
$0.38
|
| Rate for Payer: Cigna Commercial |
$0.62
|
| Rate for Payer: First Health Commercial |
$0.71
|
| Rate for Payer: Humana Commercial |
$0.64
|
| Rate for Payer: Humana KY Medicaid |
$0.26
|
| Rate for Payer: Kentucky WC Medicaid |
$0.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.66
|
| Rate for Payer: Ohio Health Group HMO |
$0.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.52
|
| Rate for Payer: PHCS Commercial |
$0.72
|
| Rate for Payer: United Healthcare All Payer |
$0.66
|
|
