|
CORRJ HALUX RIGDUS W/O IMPLT
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 28289
|
| Hospital Charge Code |
76101002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.42 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna Commercial |
$830.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$233.42
|
| Rate for Payer: Anthem Medicaid |
$284.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,750.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$905.96
|
| Rate for Payer: Healthspan PPO |
$921.30
|
| Rate for Payer: Humana Medicaid |
$284.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$683.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$290.46
|
| Rate for Payer: Molina Healthcare Passport |
$284.76
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,225.00
|
| Rate for Payer: UHCCP Medicaid |
$245.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.61
|
|
|
CORRJ HALUX RIGDUS W/O IMPLT
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 28289
|
| Hospital Charge Code |
76101002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
CORRJ HALUX RIGDUS W/O IMPLT
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 28289
|
| Hospital Charge Code |
76101002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
CORSAIR MICROCATHETER 135CM
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
CORSAIR MICROCATHETER 135CM
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
CORSAIR MICROCATHETER 150CM
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
CORSAIR MICROCATHETER 150CM
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
CORTEF (HYDROCRTISONE)10MG TAB
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
NDC 59762007401
|
| Hospital Charge Code |
25000475
|
|
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
|
|
|
CORTEF (HYDROCRTISONE)10MG TAB
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
NDC 59762007401
|
| Hospital Charge Code |
25000475
|
|
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
|
|
|
CORTENEMA(HYDROCORT 100MG/60ML
|
Facility
|
OP
|
$38.43
|
|
|
Service Code
|
NDC 62559013807
|
| Hospital Charge Code |
25000476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$36.89 |
| Rate for Payer: Aetna Commercial |
$29.59
|
| Rate for Payer: Anthem Medicaid |
$13.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.98
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna Commercial |
$31.90
|
| Rate for Payer: First Health Commercial |
$36.51
|
| Rate for Payer: Humana Commercial |
$32.67
|
| Rate for Payer: Humana KY Medicaid |
$13.22
|
| Rate for Payer: Kentucky WC Medicaid |
$13.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.82
|
| Rate for Payer: Ohio Health Group HMO |
$28.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.91
|
| Rate for Payer: PHCS Commercial |
$36.89
|
| Rate for Payer: United Healthcare All Payer |
$33.82
|
|
|
CORTENEMA(HYDROCORT 100MG/60ML
|
Facility
|
IP
|
$38.43
|
|
|
Service Code
|
NDC 62559013807
|
| Hospital Charge Code |
25000476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$36.89 |
| Rate for Payer: Humana Commercial |
$32.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$33.82
|
| Rate for Payer: Ohio Health Group HMO |
$28.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.91
|
| Rate for Payer: PHCS Commercial |
$36.89
|
| Rate for Payer: United Healthcare All Payer |
$33.82
|
| Rate for Payer: Aetna Commercial |
$29.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.98
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna Commercial |
$31.90
|
| Rate for Payer: First Health Commercial |
$36.51
|
|
|
CORTISOL RANDOM
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
30000288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.01
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
CORTISOL RANDOM
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
30000288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$131.52 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Anthem Medicaid |
$16.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.30
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna Commercial |
$113.71
|
| Rate for Payer: First Health Commercial |
$130.15
|
| Rate for Payer: Humana Commercial |
$116.45
|
| Rate for Payer: Humana KY Medicaid |
$16.30
|
| Rate for Payer: Humana Medicare Advantage |
$16.30
|
| Rate for Payer: Kentucky WC Medicaid |
$16.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$112.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$120.56
|
| Rate for Payer: Ohio Health Group HMO |
$102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.47
|
| Rate for Payer: PHCS Commercial |
$131.52
|
| Rate for Payer: United Healthcare All Payer |
$120.56
|
|
|
CORTISPORIN OPHTH SUSPEN 7.5ML
|
Facility
|
OP
|
$3.78
|
|
|
Service Code
|
NDC 61314064175
|
| Hospital Charge Code |
25000478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Anthem Medicaid |
$1.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.95
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna Commercial |
$3.14
|
| Rate for Payer: First Health Commercial |
$3.59
|
| Rate for Payer: Humana Commercial |
$3.21
|
| Rate for Payer: Humana KY Medicaid |
$1.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.33
|
| Rate for Payer: Ohio Health Group HMO |
$2.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.17
|
| Rate for Payer: PHCS Commercial |
$3.63
|
| Rate for Payer: United Healthcare All Payer |
$3.33
|
|
|
CORTISPORIN OPHTH SUSPEN 7.5ML
|
Facility
|
IP
|
$3.78
|
|
|
Service Code
|
NDC 61314064175
|
| Hospital Charge Code |
25000478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.95
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cigna Commercial |
$3.14
|
| Rate for Payer: First Health Commercial |
$3.59
|
| Rate for Payer: Humana Commercial |
$3.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.33
|
| Rate for Payer: Ohio Health Group HMO |
$2.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.17
|
| Rate for Payer: PHCS Commercial |
$3.63
|
| Rate for Payer: United Healthcare All Payer |
$3.33
|
|
|
CORTISPORIN OTIC SOLUTION 10ML
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
NDC 61314064610
|
| Hospital Charge Code |
25000480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna Commercial |
$1.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.24
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna Commercial |
$1.32
|
| Rate for Payer: First Health Commercial |
$1.51
|
| Rate for Payer: Humana Commercial |
$1.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.40
|
| Rate for Payer: Ohio Health Group HMO |
$1.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.49
|
| Rate for Payer: PHCS Commercial |
$1.53
|
| Rate for Payer: United Healthcare All Payer |
$1.40
|
|
|
CORTISPORIN OTIC SOLUTION 10ML
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
NDC 61314064610
|
| Hospital Charge Code |
25000480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna Commercial |
$1.22
|
| Rate for Payer: Anthem Medicaid |
$0.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.24
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna Commercial |
$1.32
|
| Rate for Payer: First Health Commercial |
$1.51
|
| Rate for Payer: Humana Commercial |
$1.35
|
| Rate for Payer: Humana KY Medicaid |
$0.55
|
| Rate for Payer: Kentucky WC Medicaid |
$0.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.40
|
| Rate for Payer: Ohio Health Group HMO |
$1.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.49
|
| Rate for Payer: PHCS Commercial |
$1.53
|
| Rate for Payer: United Healthcare All Payer |
$1.40
|
|
|
CORTISPORIN OTIC SUSPENSI 10ML
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
25000482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna Commercial |
$1.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.24
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna Commercial |
$1.32
|
| Rate for Payer: First Health Commercial |
$1.51
|
| Rate for Payer: Humana Commercial |
$1.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.40
|
| Rate for Payer: Ohio Health Group HMO |
$1.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.49
|
| Rate for Payer: PHCS Commercial |
$1.53
|
| Rate for Payer: United Healthcare All Payer |
$1.40
|
|
|
CORTISPORIN OTIC SUSPENSI 10ML
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
25000482
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna Commercial |
$1.22
|
| Rate for Payer: Anthem Medicaid |
$0.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.24
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna Commercial |
$1.32
|
| Rate for Payer: First Health Commercial |
$1.51
|
| Rate for Payer: Humana Commercial |
$1.35
|
| Rate for Payer: Humana KY Medicaid |
$0.55
|
| Rate for Payer: Kentucky WC Medicaid |
$0.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.40
|
| Rate for Payer: Ohio Health Group HMO |
$1.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.49
|
| Rate for Payer: PHCS Commercial |
$1.53
|
| Rate for Payer: United Healthcare All Payer |
$1.40
|
|
|
CortisporinTC Otic Susp 10mL
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
NDC 63481052910
|
| Hospital Charge Code |
25004170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.54
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna Commercial |
$2.70
|
| Rate for Payer: First Health Commercial |
$3.09
|
| Rate for Payer: Humana Commercial |
$2.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.86
|
| Rate for Payer: Ohio Health Group HMO |
$2.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.01
|
| Rate for Payer: PHCS Commercial |
$3.12
|
| Rate for Payer: United Healthcare All Payer |
$2.86
|
|
|
CortisporinTC Otic Susp 10mL
|
Facility
|
OP
|
$3.25
|
|
|
Service Code
|
NDC 63481052910
|
| Hospital Charge Code |
25004170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Anthem Medicaid |
$1.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.54
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna Commercial |
$2.70
|
| Rate for Payer: First Health Commercial |
$3.09
|
| Rate for Payer: Humana Commercial |
$2.76
|
| Rate for Payer: Humana KY Medicaid |
$1.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.86
|
| Rate for Payer: Ohio Health Group HMO |
$2.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.01
|
| Rate for Payer: PHCS Commercial |
$3.12
|
| Rate for Payer: United Healthcare All Payer |
$2.86
|
|
|
CORTROSYN 0.25MG/1ML VIAL
|
Facility
|
IP
|
$534.58
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
25001970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$513.20 |
| Rate for Payer: Aetna Commercial |
$411.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.97
|
| Rate for Payer: Cash Price |
$267.29
|
| Rate for Payer: Cigna Commercial |
$443.70
|
| Rate for Payer: First Health Commercial |
$507.85
|
| Rate for Payer: Humana Commercial |
$454.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.43
|
| Rate for Payer: Ohio Health Group HMO |
$400.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.72
|
| Rate for Payer: PHCS Commercial |
$513.20
|
| Rate for Payer: United Healthcare All Payer |
$470.43
|
|
|
CORTROSYN 0.25MG/1ML VIAL
|
Facility
|
OP
|
$534.58
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
25001970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$513.20 |
| Rate for Payer: Aetna Commercial |
$411.63
|
| Rate for Payer: Anthem Medicaid |
$183.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.97
|
| Rate for Payer: Cash Price |
$267.29
|
| Rate for Payer: Cigna Commercial |
$443.70
|
| Rate for Payer: First Health Commercial |
$507.85
|
| Rate for Payer: Humana Commercial |
$454.39
|
| Rate for Payer: Humana KY Medicaid |
$183.84
|
| Rate for Payer: Kentucky WC Medicaid |
$185.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.43
|
| Rate for Payer: Ohio Health Group HMO |
$400.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.72
|
| Rate for Payer: PHCS Commercial |
$513.20
|
| Rate for Payer: United Healthcare All Payer |
$470.43
|
|
|
CORVERT (IBUTILIDE) 1MG/10ML
|
Facility
|
OP
|
$686.85
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
25002159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.29 |
| Max. Negotiated Rate |
$659.38 |
| Rate for Payer: Aetna Commercial |
$528.87
|
| Rate for Payer: Anthem Medicaid |
$236.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$190.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$535.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$266.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$256.83
|
| Rate for Payer: Cash Price |
$343.42
|
| Rate for Payer: Cash Price |
$343.42
|
| Rate for Payer: Cigna Commercial |
$570.09
|
| Rate for Payer: First Health Commercial |
$652.51
|
| Rate for Payer: Humana Commercial |
$583.82
|
| Rate for Payer: Humana KY Medicaid |
$236.21
|
| Rate for Payer: Humana Medicare Advantage |
$190.24
|
| Rate for Payer: Kentucky WC Medicaid |
$238.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$563.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$506.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$240.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$604.43
|
| Rate for Payer: Ohio Health Group HMO |
$515.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.92
|
| Rate for Payer: PHCS Commercial |
$659.38
|
| Rate for Payer: United Healthcare All Payer |
$604.43
|
|
|
CORVERT (IBUTILIDE) 1MG/10ML
|
Facility
|
IP
|
$686.85
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
25002159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.29 |
| Max. Negotiated Rate |
$659.38 |
| Rate for Payer: Aetna Commercial |
$528.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$535.74
|
| Rate for Payer: Cash Price |
$343.42
|
| Rate for Payer: Cigna Commercial |
$570.09
|
| Rate for Payer: First Health Commercial |
$652.51
|
| Rate for Payer: Humana Commercial |
$583.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$563.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$506.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$604.43
|
| Rate for Payer: Ohio Health Group HMO |
$515.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.92
|
| Rate for Payer: PHCS Commercial |
$659.38
|
| Rate for Payer: United Healthcare All Payer |
$604.43
|
|
