|
CHONDRAL DART 18MM
|
Facility
|
OP
|
$4,382.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,314.66 |
| Max. Negotiated Rate |
$4,206.90 |
| Rate for Payer: Aetna Commercial |
$3,374.29
|
| Rate for Payer: Anthem Medicaid |
$1,507.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,418.11
|
| Rate for Payer: Cash Price |
$2,191.09
|
| Rate for Payer: Cigna Commercial |
$3,637.22
|
| Rate for Payer: First Health Commercial |
$4,163.08
|
| Rate for Payer: Humana Commercial |
$3,724.86
|
| Rate for Payer: Humana KY Medicaid |
$1,507.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,522.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,234.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,537.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.33
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,505.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,812.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.71
|
| Rate for Payer: PHCS Commercial |
$4,206.90
|
| Rate for Payer: United Healthcare All Payer |
$3,856.33
|
|
|
CHROMOGENIC FACTOR
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
HCPCS 85130
|
| Hospital Charge Code |
30001797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$421.44 |
| Rate for Payer: Aetna Commercial |
$338.03
|
| Rate for Payer: Anthem Medicaid |
$11.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$352.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.89
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cigna Commercial |
$364.37
|
| Rate for Payer: First Health Commercial |
$417.05
|
| Rate for Payer: Humana Commercial |
$373.15
|
| Rate for Payer: Humana KY Medicaid |
$11.89
|
| Rate for Payer: Humana Medicare Advantage |
$11.89
|
| Rate for Payer: Kentucky WC Medicaid |
$12.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.32
|
| Rate for Payer: Ohio Health Group HMO |
$329.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$381.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.91
|
| Rate for Payer: PHCS Commercial |
$421.44
|
| Rate for Payer: United Healthcare All Payer |
$386.32
|
|
|
CHROMOGENIC FACTOR
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
HCPCS 85130
|
| Hospital Charge Code |
30001797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.70 |
| Max. Negotiated Rate |
$421.44 |
| Rate for Payer: Aetna Commercial |
$338.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$352.52
|
| Rate for Payer: Cash Price |
$219.50
|
| Rate for Payer: Cigna Commercial |
$364.37
|
| Rate for Payer: First Health Commercial |
$417.05
|
| Rate for Payer: Humana Commercial |
$373.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.32
|
| Rate for Payer: Ohio Health Group HMO |
$329.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$381.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.91
|
| Rate for Payer: PHCS Commercial |
$421.44
|
| Rate for Payer: United Healthcare All Payer |
$386.32
|
|
|
CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS
|
Facility
|
OP
|
$6,385.65
|
|
|
Service Code
|
CPT 58350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,561.18 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
|
|
CICLOPIROX 8% SOLUTION 6.6ML
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
NDC 45802014167
|
| Hospital Charge Code |
25002938
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Anthem Medicaid |
$1.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.57
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cigna Commercial |
$2.74
|
| Rate for Payer: First Health Commercial |
$3.13
|
| Rate for Payer: Humana Commercial |
$2.81
|
| Rate for Payer: Humana KY Medicaid |
$1.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.90
|
| Rate for Payer: Ohio Health Group HMO |
$2.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.28
|
| Rate for Payer: PHCS Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Payer |
$2.90
|
|
|
CICLOPIROX 8% SOLUTION 6.6ML
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
NDC 45802014167
|
| Hospital Charge Code |
25002938
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.57
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cigna Commercial |
$2.74
|
| Rate for Payer: First Health Commercial |
$3.13
|
| Rate for Payer: Humana Commercial |
$2.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.90
|
| Rate for Payer: Ohio Health Group HMO |
$2.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.28
|
| Rate for Payer: PHCS Commercial |
$3.17
|
| Rate for Payer: United Healthcare All Payer |
$2.90
|
|
|
CILOXAN (CIPROFLOXACI)3% 2.5ML
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
NDC 69315030802
|
| Hospital Charge Code |
25002939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna Commercial |
$1.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.33
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna Commercial |
$1.42
|
| Rate for Payer: First Health Commercial |
$1.62
|
| Rate for Payer: Humana Commercial |
$1.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.50
|
| Rate for Payer: Ohio Health Group HMO |
$1.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.18
|
| Rate for Payer: PHCS Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Payer |
$1.50
|
|
|
CILOXAN (CIPROFLOXACI)3% 2.5ML
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
NDC 69315030802
|
| Hospital Charge Code |
25002939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna Commercial |
$1.32
|
| Rate for Payer: Anthem Medicaid |
$0.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.33
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna Commercial |
$1.42
|
| Rate for Payer: First Health Commercial |
$1.62
|
| Rate for Payer: Humana Commercial |
$1.45
|
| Rate for Payer: Humana KY Medicaid |
$0.59
|
| Rate for Payer: Kentucky WC Medicaid |
$0.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.50
|
| Rate for Payer: Ohio Health Group HMO |
$1.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.18
|
| Rate for Payer: PHCS Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Payer |
$1.50
|
|
|
CILOXAN(CIPROFLOXACIN)3.5GMONT
|
Facility
|
OP
|
$29.23
|
|
|
Service Code
|
NDC 66758007138
|
| Hospital Charge Code |
25002940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$28.06 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Anthem Medicaid |
$10.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.80
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cigna Commercial |
$24.26
|
| Rate for Payer: First Health Commercial |
$27.77
|
| Rate for Payer: Humana Commercial |
$24.85
|
| Rate for Payer: Humana KY Medicaid |
$10.05
|
| Rate for Payer: Kentucky WC Medicaid |
$10.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.72
|
| Rate for Payer: Ohio Health Group HMO |
$21.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.17
|
| Rate for Payer: PHCS Commercial |
$28.06
|
| Rate for Payer: United Healthcare All Payer |
$25.72
|
|
|
CILOXAN(CIPROFLOXACIN)3.5GMONT
|
Facility
|
IP
|
$29.23
|
|
|
Service Code
|
NDC 66758007138
|
| Hospital Charge Code |
25002940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$28.06 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.80
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cigna Commercial |
$24.26
|
| Rate for Payer: First Health Commercial |
$27.77
|
| Rate for Payer: Humana Commercial |
$24.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.72
|
| Rate for Payer: Ohio Health Group HMO |
$21.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.17
|
| Rate for Payer: PHCS Commercial |
$28.06
|
| Rate for Payer: United Healthcare All Payer |
$25.72
|
|
|
CINE/VID X-RAY THROAT/ESOPH
|
Facility
|
IP
|
$798.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$766.08 |
| Rate for Payer: Aetna Commercial |
$614.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$622.44
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$662.34
|
| Rate for Payer: First Health Commercial |
$758.10
|
| Rate for Payer: Humana Commercial |
$678.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$654.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$588.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$702.24
|
| Rate for Payer: Ohio Health Group HMO |
$598.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$694.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.62
|
| Rate for Payer: PHCS Commercial |
$766.08
|
| Rate for Payer: United Healthcare All Payer |
$702.24
|
|
|
CINE/VID X-RAY THROAT/ESOPH
|
Professional
|
Both
|
$798.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna Commercial |
$134.95
|
| Rate for Payer: Ambetter Exchange |
$109.24
|
| Rate for Payer: Anthem Medicaid |
$96.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$109.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.09
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$120.01
|
| Rate for Payer: Healthspan PPO |
$126.45
|
| Rate for Payer: Humana Medicaid |
$96.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$109.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$98.04
|
| Rate for Payer: Molina Healthcare Passport |
$96.12
|
| Rate for Payer: Multiplan PHCS |
$478.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$142.01
|
| Rate for Payer: UHCCP Medicaid |
$279.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$97.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$109.24
|
|
|
CINE/VID X-RAY THROAT/ESOPH
|
Facility
|
OP
|
$798.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
32000130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$766.08 |
| Rate for Payer: Aetna Commercial |
$614.46
|
| Rate for Payer: Anthem Medicaid |
$274.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$622.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$662.34
|
| Rate for Payer: First Health Commercial |
$758.10
|
| Rate for Payer: Humana Commercial |
$678.30
|
| Rate for Payer: Humana KY Medicaid |
$274.43
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$277.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$654.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$588.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$279.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$702.24
|
| Rate for Payer: Ohio Health Group HMO |
$598.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$694.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.62
|
| Rate for Payer: PHCS Commercial |
$766.08
|
| Rate for Payer: United Healthcare All Payer |
$702.24
|
|
|
CINE/VID X-RAY THROAT/ESOPH(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
320P0130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$142.01 |
| Rate for Payer: Aetna Commercial |
$134.95
|
| Rate for Payer: Ambetter Exchange |
$109.24
|
| Rate for Payer: Anthem Medicaid |
$96.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$109.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$109.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.09
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$120.01
|
| Rate for Payer: Healthspan PPO |
$126.45
|
| Rate for Payer: Humana Medicaid |
$96.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$109.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$98.04
|
| Rate for Payer: Molina Healthcare Passport |
$96.12
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$142.01
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$97.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$109.24
|
|
|
CINE/VID X-RAY THROAT/ESOPH(T
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
320T0130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$670.08 |
| Rate for Payer: Aetna Commercial |
$537.46
|
| Rate for Payer: Anthem Medicaid |
$240.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$544.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$349.00
|
| Rate for Payer: Cash Price |
$349.00
|
| Rate for Payer: Cigna Commercial |
$579.34
|
| Rate for Payer: First Health Commercial |
$663.10
|
| Rate for Payer: Humana Commercial |
$593.30
|
| Rate for Payer: Humana KY Medicaid |
$240.04
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$242.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$572.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$515.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$244.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$614.24
|
| Rate for Payer: Ohio Health Group HMO |
$523.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$607.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$481.62
|
| Rate for Payer: PHCS Commercial |
$670.08
|
| Rate for Payer: United Healthcare All Payer |
$614.24
|
|
|
CINE/VID X-RAY THROAT/ESOPH(T
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
HCPCS 74230
|
| Hospital Charge Code |
320T0130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$209.40 |
| Max. Negotiated Rate |
$670.08 |
| Rate for Payer: Aetna Commercial |
$537.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$544.44
|
| Rate for Payer: Cash Price |
$349.00
|
| Rate for Payer: Cigna Commercial |
$579.34
|
| Rate for Payer: First Health Commercial |
$663.10
|
| Rate for Payer: Humana Commercial |
$593.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$572.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$515.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$614.24
|
| Rate for Payer: Ohio Health Group HMO |
$523.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$607.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$481.62
|
| Rate for Payer: PHCS Commercial |
$670.08
|
| Rate for Payer: United Healthcare All Payer |
$614.24
|
|
|
CINQAIR 10MG/ML VIAL (10ML)
|
Facility
|
OP
|
$6,071.30
|
|
|
Service Code
|
HCPCS J2786
|
| Hospital Charge Code |
25002341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$5,828.45 |
| Rate for Payer: Aetna Commercial |
$4,674.90
|
| Rate for Payer: Anthem Medicaid |
$2,087.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,735.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.28
|
| Rate for Payer: Cash Price |
$3,035.65
|
| Rate for Payer: Cash Price |
$3,035.65
|
| Rate for Payer: Cigna Commercial |
$5,039.18
|
| Rate for Payer: First Health Commercial |
$5,767.73
|
| Rate for Payer: Humana Commercial |
$5,160.60
|
| Rate for Payer: Humana KY Medicaid |
$2,087.92
|
| Rate for Payer: Humana Medicare Advantage |
$10.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,109.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,978.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,480.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,129.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,342.74
|
| Rate for Payer: Ohio Health Group HMO |
$4,553.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,857.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,282.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,189.20
|
| Rate for Payer: PHCS Commercial |
$5,828.45
|
| Rate for Payer: United Healthcare All Payer |
$5,342.74
|
|
|
CINQAIR 10MG/ML VIAL (10ML)
|
Facility
|
IP
|
$6,071.30
|
|
|
Service Code
|
HCPCS J2786
|
| Hospital Charge Code |
25002341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,821.39 |
| Max. Negotiated Rate |
$5,828.45 |
| Rate for Payer: Aetna Commercial |
$4,674.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,735.61
|
| Rate for Payer: Cash Price |
$3,035.65
|
| Rate for Payer: Cigna Commercial |
$5,039.18
|
| Rate for Payer: First Health Commercial |
$5,767.73
|
| Rate for Payer: Humana Commercial |
$5,160.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,978.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,480.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,821.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,342.74
|
| Rate for Payer: Ohio Health Group HMO |
$4,553.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,857.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,282.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,189.20
|
| Rate for Payer: PHCS Commercial |
$5,828.45
|
| Rate for Payer: United Healthcare All Payer |
$5,342.74
|
|
|
CIPRO 200MG(400MG PREMIX IVPB)
|
Facility
|
IP
|
$70.99
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
25001865
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.30 |
| 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 |
$56.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.98
|
| Rate for Payer: PHCS Commercial |
$68.15
|
| Rate for Payer: United Healthcare All Payer |
$62.47
|
|
|
CIPRO 200MG(400MG PREMIX IVPB)
|
Facility
|
OP
|
$70.99
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
25001865
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.30 |
| 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 |
$56.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.98
|
| Rate for Payer: PHCS Commercial |
$68.15
|
| Rate for Payer: United Healthcare All Payer |
$62.47
|
|
|
CIPRO(CIPROFLOXACIN 250MG/1TAB
|
Facility
|
IP
|
$4.43
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25000420
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| 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 |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
CIPRO(CIPROFLOXACIN 250MG/1TAB
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
NDC 65862007601
|
| Hospital Charge Code |
25000420
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| 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 |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
CIPRO(CIPROFLOXACIN 500MG/1TAB
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 904724361
|
| Hospital Charge Code |
25000421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
CIPRO(CIPROFLOXACIN 500MG/1TAB
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 904724361
|
| Hospital Charge Code |
25000421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
CIPRO(CIPROFLOXACIN 750MG/1TAB
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 143992950
|
| Hospital Charge Code |
25000422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| 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 |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
