|
CIPRO 200MG(400MG PREMIX IVPB)
|
Facility
|
OP
|
$70.99
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
25001865
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$68.15 |
| Rate for Payer: Aetna Commercial |
$54.66
|
| Rate for Payer: Anthem Medicaid |
$24.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.37
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Cigna Commercial |
$58.92
|
| Rate for Payer: First Health Commercial |
$67.44
|
| Rate for Payer: Humana Commercial |
$60.34
|
| Rate for Payer: Humana KY Medicaid |
$24.41
|
| Rate for Payer: Kentucky WC Medicaid |
$24.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.47
|
| Rate for Payer: Ohio Health Group HMO |
$53.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.01
|
| Rate for Payer: PHCS Commercial |
$68.15
|
| Rate for Payer: United Healthcare All Payer |
$62.47
|
|
|
CIPRO 200MG(400MG PREMIX IVPB)
|
Facility
|
IP
|
$70.99
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
25001865
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$68.15 |
| Rate for Payer: Aetna Commercial |
$54.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.37
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Cigna Commercial |
$58.92
|
| Rate for Payer: First Health Commercial |
$67.44
|
| Rate for Payer: Humana Commercial |
$60.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.47
|
| Rate for Payer: Ohio Health Group HMO |
$53.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.01
|
| Rate for Payer: PHCS Commercial |
$68.15
|
| Rate for Payer: United Healthcare All Payer |
$62.47
|
|
|
CIPRO(CIPROFLOXACIN 250MG/1TAB
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25000420
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
CIPRO(CIPROFLOXACIN 250MG/1TAB
|
Facility
|
IP
|
$4.43
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25000420
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
CIPRO(CIPROFLOXACIN 500MG/1TAB
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
NDC 904724361
|
| Hospital Charge Code |
25000421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
CIPRO(CIPROFLOXACIN 500MG/1TAB
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
NDC 904724361
|
| Hospital Charge Code |
25000421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
CIPRO(CIPROFLOXACIN 750MG/1TAB
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 143992950
|
| Hospital Charge Code |
25000422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
CIPRO(CIPROFLOXACIN 750MG/1TAB
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 143992950
|
| Hospital Charge Code |
25000422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
CIPRODEX OTIC DROPS
|
Facility
|
OP
|
$3.95
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
25000423
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$3.04
|
| Rate for Payer: Anthem Medicaid |
$1.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.08
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna Commercial |
$3.28
|
| Rate for Payer: First Health Commercial |
$3.75
|
| Rate for Payer: Humana Commercial |
$3.36
|
| Rate for Payer: Humana KY Medicaid |
$1.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.48
|
| Rate for Payer: Ohio Health Group HMO |
$2.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.22
|
| Rate for Payer: PHCS Commercial |
$3.79
|
| Rate for Payer: United Healthcare All Payer |
$3.48
|
|
|
CIPRODEX OTIC DROPS
|
Facility
|
IP
|
$3.95
|
|
|
Service Code
|
NDC 43598032675
|
| Hospital Charge Code |
25000423
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.48
|
| Rate for Payer: Ohio Health Group HMO |
$2.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.22
|
| Rate for Payer: PHCS Commercial |
$3.79
|
| Rate for Payer: United Healthcare All Payer |
$3.48
|
| Rate for Payer: Aetna Commercial |
$3.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.08
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cigna Commercial |
$3.28
|
| Rate for Payer: First Health Commercial |
$3.75
|
| Rate for Payer: Humana Commercial |
$3.36
|
|
|
CIPROFLOXACIN 0.3%EYEDROP(5ML)
|
Facility
|
OP
|
$0.89
|
|
|
Service Code
|
NDC 69315030805
|
| Hospital Charge Code |
25002941
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna Commercial |
$0.69
|
| Rate for Payer: Anthem Medicaid |
$0.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna Commercial |
$0.74
|
| Rate for Payer: First Health Commercial |
$0.85
|
| Rate for Payer: Humana Commercial |
$0.76
|
| Rate for Payer: Humana KY Medicaid |
$0.31
|
| Rate for Payer: Kentucky WC Medicaid |
$0.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.78
|
| Rate for Payer: Ohio Health Group HMO |
$0.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.28
|
| Rate for Payer: PHCS Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Payer |
$0.78
|
|
|
CIPROFLOXACIN 0.3%EYEDROP(5ML)
|
Facility
|
IP
|
$0.89
|
|
|
Service Code
|
NDC 69315030805
|
| Hospital Charge Code |
25002941
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Aetna Commercial |
$0.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna Commercial |
$0.74
|
| Rate for Payer: First Health Commercial |
$0.85
|
| Rate for Payer: Humana Commercial |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.78
|
| Rate for Payer: Ohio Health Group HMO |
$0.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.28
|
| Rate for Payer: PHCS Commercial |
$0.85
|
| Rate for Payer: United Healthcare All Payer |
$0.78
|
|
|
CIPROFLOXACN HCL OPTH SOL 0.3%
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
25002939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CIPROFLOXACN HCL OPTH SOL 0.3%
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
25002939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CIPROHC(CIPROFLOXACIN)OTICSUSP
|
Facility
|
IP
|
$4.85
|
|
|
Service Code
|
NDC 78085526
|
| Hospital Charge Code |
25000419
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.66 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.78
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.61
|
| Rate for Payer: Humana Commercial |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.27
|
| Rate for Payer: Ohio Health Group HMO |
$3.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.50
|
| Rate for Payer: PHCS Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Payer |
$4.27
|
|
|
CIPROHC(CIPROFLOXACIN)OTICSUSP
|
Facility
|
OP
|
$4.85
|
|
|
Service Code
|
NDC 78085526
|
| Hospital Charge Code |
25000419
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.66 |
| Rate for Payer: Aetna Commercial |
$3.73
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.78
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cigna Commercial |
$4.03
|
| Rate for Payer: First Health Commercial |
$4.61
|
| Rate for Payer: Humana Commercial |
$4.12
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.27
|
| Rate for Payer: Ohio Health Group HMO |
$3.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.50
|
| Rate for Payer: PHCS Commercial |
$4.66
|
| Rate for Payer: United Healthcare All Payer |
$4.27
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$25,216.63
|
|
|
Service Code
|
MSDRG 286
|
| Min. Negotiated Rate |
$17,111.29 |
| Max. Negotiated Rate |
$25,216.63 |
| Rate for Payer: Anthem Medicaid |
$17,111.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,011.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25,216.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$24,316.04
|
| Rate for Payer: Humana KY Medicaid |
$17,111.29
|
| Rate for Payer: Humana Medicare Advantage |
$18,011.88
|
| Rate for Payer: Kentucky WC Medicaid |
$17,282.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,614.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,453.51
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$12,652.78
|
|
|
Service Code
|
MSDRG 287
|
| Min. Negotiated Rate |
$8,585.82 |
| Max. Negotiated Rate |
$12,652.78 |
| Rate for Payer: Anthem Medicaid |
$8,585.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,037.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,652.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,200.90
|
| Rate for Payer: Humana KY Medicaid |
$8,585.82
|
| Rate for Payer: Humana Medicare Advantage |
$9,037.70
|
| Rate for Payer: Kentucky WC Medicaid |
$8,671.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,845.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,757.53
|
|
|
CIRCUM 28 DAYS OR OLDER
|
Facility
|
OP
|
$6,653.28
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
76102132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$864.93 |
| Max. Negotiated Rate |
$6,387.15 |
| Rate for Payer: Aetna Commercial |
$5,123.03
|
| Rate for Payer: Anthem Medicaid |
$2,288.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,189.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$3,326.64
|
| Rate for Payer: Cash Price |
$3,326.64
|
| Rate for Payer: Cigna Commercial |
$5,522.22
|
| Rate for Payer: First Health Commercial |
$6,320.62
|
| Rate for Payer: Humana Commercial |
$5,655.29
|
| Rate for Payer: Humana KY Medicaid |
$2,288.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,311.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,455.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,910.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,333.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,854.89
|
| Rate for Payer: Ohio Health Group HMO |
$4,989.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,330.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$864.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,062.52
|
| Rate for Payer: PHCS Commercial |
$6,387.15
|
| Rate for Payer: United Healthcare All Payer |
$5,854.89
|
|
|
CIRCUM 28 DAYS OR OLDER
|
Professional
|
Both
|
$6,653.28
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
76102132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.28 |
| Max. Negotiated Rate |
$6,653.28 |
| Rate for Payer: Aetna Commercial |
$319.78
|
| Rate for Payer: Anthem Medicaid |
$158.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,653.28
|
| Rate for Payer: Cash Price |
$3,326.64
|
| Rate for Payer: Cash Price |
$3,326.64
|
| Rate for Payer: Cigna Commercial |
$283.19
|
| Rate for Payer: Healthspan PPO |
$309.63
|
| Rate for Payer: Humana Medicaid |
$158.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$268.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.45
|
| Rate for Payer: Molina Healthcare Passport |
$158.28
|
| Rate for Payer: Multiplan PHCS |
$3,991.97
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,657.30
|
| Rate for Payer: UHCCP Medicaid |
$2,328.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.86
|
|
|
CIRCUM 28 DAYS OR OLDER
|
Facility
|
IP
|
$6,653.28
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
76102132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$864.93 |
| Max. Negotiated Rate |
$6,387.15 |
| Rate for Payer: Aetna Commercial |
$5,123.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,189.56
|
| Rate for Payer: Cash Price |
$3,326.64
|
| Rate for Payer: Cigna Commercial |
$5,522.22
|
| Rate for Payer: First Health Commercial |
$6,320.62
|
| Rate for Payer: Humana Commercial |
$5,655.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,455.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,910.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,854.89
|
| Rate for Payer: Ohio Health Group HMO |
$4,989.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,330.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$864.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,062.52
|
| Rate for Payer: PHCS Commercial |
$6,387.15
|
| Rate for Payer: United Healthcare All Payer |
$5,854.89
|
|
|
CIRCUM 28 DAYS OR OLDER(P
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
761P2132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.28 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$319.78
|
| Rate for Payer: Anthem Medicaid |
$158.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$283.19
|
| Rate for Payer: Healthspan PPO |
$309.63
|
| Rate for Payer: Humana Medicaid |
$158.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$268.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.45
|
| Rate for Payer: Molina Healthcare Passport |
$158.28
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$218.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.86
|
|
|
CIRCUM 28 DAYS OR OLDER(T
|
Facility
|
OP
|
$6,028.28
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
761T2132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$783.68 |
| Max. Negotiated Rate |
$5,787.15 |
| Rate for Payer: Aetna Commercial |
$4,641.78
|
| Rate for Payer: Anthem Medicaid |
$2,073.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,702.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$3,014.14
|
| Rate for Payer: Cash Price |
$3,014.14
|
| Rate for Payer: Cigna Commercial |
$5,003.47
|
| Rate for Payer: First Health Commercial |
$5,726.87
|
| Rate for Payer: Humana Commercial |
$5,124.04
|
| Rate for Payer: Humana KY Medicaid |
$2,073.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,094.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,943.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,448.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,114.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,304.89
|
| Rate for Payer: Ohio Health Group HMO |
$4,521.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,205.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,868.77
|
| Rate for Payer: PHCS Commercial |
$5,787.15
|
| Rate for Payer: United Healthcare All Payer |
$5,304.89
|
|
|
CIRCUM 28 DAYS OR OLDER(T
|
Facility
|
IP
|
$6,028.28
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
761T2132
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$783.68 |
| Max. Negotiated Rate |
$5,787.15 |
| Rate for Payer: Aetna Commercial |
$4,641.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,702.06
|
| Rate for Payer: Cash Price |
$3,014.14
|
| Rate for Payer: Cigna Commercial |
$5,003.47
|
| Rate for Payer: First Health Commercial |
$5,726.87
|
| Rate for Payer: Humana Commercial |
$5,124.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,943.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,448.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,808.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,304.89
|
| Rate for Payer: Ohio Health Group HMO |
$4,521.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,205.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,868.77
|
| Rate for Payer: PHCS Commercial |
$5,787.15
|
| Rate for Payer: United Healthcare All Payer |
$5,304.89
|
|
|
CIRCUMCISION NEONATE
|
Professional
|
Both
|
$1,422.00
|
|
|
Service Code
|
HCPCS 54160
|
| Hospital Charge Code |
76102131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$1,422.00 |
| Rate for Payer: Aetna Commercial |
$236.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.54
|
| Rate for Payer: Anthem Medicaid |
$120.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,422.00
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cash Price |
$711.00
|
| Rate for Payer: Cigna Commercial |
$209.22
|
| Rate for Payer: Healthspan PPO |
$357.03
|
| Rate for Payer: Humana Medicaid |
$120.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$195.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.35
|
| Rate for Payer: Molina Healthcare Passport |
$120.93
|
| Rate for Payer: Multiplan PHCS |
$853.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$995.40
|
| Rate for Payer: UHCCP Medicaid |
$77.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.14
|
|
