|
CORSAIR MICROCATHETER 135CM
|
Facility
|
OP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem Medicaid |
$1,590.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Humana KY Medicaid |
$1,590.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,606.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
CORTEF (HYDROCRTISONE)10MG TAB
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
NDC 59762007401
|
| Hospital Charge Code |
25000475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| 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 |
$3.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
CORTEF (HYDROCRTISONE)10MG TAB
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
NDC 59762007401
|
| Hospital Charge Code |
25000475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| 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 |
$3.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
CORTENEMA(HYDROCORT 100MG/60ML
|
Facility
|
IP
|
$38.43
|
|
|
Service Code
|
NDC 62559013807
|
| Hospital Charge Code |
25000476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$36.89 |
| 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
|
| 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 |
$30.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.52
|
| Rate for Payer: PHCS Commercial |
$36.89
|
| Rate for Payer: United Healthcare All Payer |
$33.82
|
|
|
CORTENEMA(HYDROCORT 100MG/60ML
|
Facility
|
OP
|
$38.43
|
|
|
Service Code
|
NDC 62559013807
|
| Hospital Charge Code |
25000476
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.53 |
| 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 |
$30.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.52
|
| Rate for Payer: PHCS Commercial |
$36.89
|
| Rate for Payer: United Healthcare All Payer |
$33.82
|
|
|
CORTISOL RANDOM
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
30000288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem Medicaid |
$16.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.30
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| 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 |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.05
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
CORTISOL RANDOM
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
30000288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: Aetna Commercial |
$111.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.44
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cigna Commercial |
$120.35
|
| Rate for Payer: First Health Commercial |
$137.75
|
| Rate for Payer: Humana Commercial |
$123.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
| Rate for Payer: Ohio Health Group HMO |
$108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.05
|
| Rate for Payer: PHCS Commercial |
$139.20
|
| Rate for Payer: United Healthcare All Payer |
$127.60
|
|
|
CORTISPORIN OPHTH SUSPEN 7.5ML
|
Facility
|
OP
|
$3.78
|
|
|
Service Code
|
NDC 61314064175
|
| Hospital Charge Code |
25000478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| 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 |
$2.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.61
|
| 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 |
$1.13 |
| 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 |
$2.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.61
|
| Rate for Payer: PHCS Commercial |
$3.63
|
| Rate for Payer: United Healthcare All Payer |
$3.33
|
|
|
CORTISPORIN OTIC SOLUTION 10ML
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
NDC 24208063110
|
| Hospital Charge Code |
25000480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| 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 |
$1.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.10
|
| Rate for Payer: PHCS Commercial |
$1.53
|
| Rate for Payer: United Healthcare All Payer |
$1.40
|
|
|
CORTISPORIN OTIC SOLUTION 10ML
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
NDC 24208063110
|
| Hospital Charge Code |
25000480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| 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 |
$1.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.10
|
| 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 |
$0.48 |
| 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 |
$1.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.10
|
| 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 |
$0.48 |
| 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 |
$1.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.10
|
| 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 |
$0.98 |
| 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 |
$2.67
|
| 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 |
$2.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.24
|
| 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 |
$0.98 |
| 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 |
$2.67
|
| 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 |
$2.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.24
|
| 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 |
$160.37 |
| 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 |
$427.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.86
|
| 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 |
$160.37 |
| 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 |
$427.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.86
|
| Rate for Payer: PHCS Commercial |
$513.20
|
| Rate for Payer: United Healthcare All Payer |
$470.43
|
|
|
CORVERT (IBUTILIDE) 1MG/10ML
|
Facility
|
IP
|
$697.83
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
25002159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$209.35 |
| Max. Negotiated Rate |
$669.92 |
| Rate for Payer: Aetna Commercial |
$537.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$544.31
|
| Rate for Payer: Cash Price |
$348.92
|
| Rate for Payer: Cigna Commercial |
$579.20
|
| Rate for Payer: First Health Commercial |
$662.94
|
| Rate for Payer: Humana Commercial |
$593.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$572.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$515.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$614.09
|
| Rate for Payer: Ohio Health Group HMO |
$523.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$558.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$607.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$481.50
|
| Rate for Payer: PHCS Commercial |
$669.92
|
| Rate for Payer: United Healthcare All Payer |
$614.09
|
|
|
CORVERT (IBUTILIDE) 1MG/10ML
|
Facility
|
OP
|
$697.83
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
25002159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.06 |
| Max. Negotiated Rate |
$669.92 |
| Rate for Payer: Aetna Commercial |
$537.33
|
| Rate for Payer: Anthem Medicaid |
$239.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$219.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$544.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$306.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$295.73
|
| Rate for Payer: Cash Price |
$348.92
|
| Rate for Payer: Cash Price |
$348.92
|
| Rate for Payer: Cigna Commercial |
$579.20
|
| Rate for Payer: First Health Commercial |
$662.94
|
| Rate for Payer: Humana Commercial |
$593.16
|
| Rate for Payer: Humana KY Medicaid |
$239.98
|
| Rate for Payer: Humana Medicare Advantage |
$219.06
|
| Rate for Payer: Kentucky WC Medicaid |
$242.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$572.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$515.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$244.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$614.09
|
| Rate for Payer: Ohio Health Group HMO |
$523.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$558.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$607.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$481.50
|
| Rate for Payer: PHCS Commercial |
$669.92
|
| Rate for Payer: United Healthcare All Payer |
$614.09
|
|
|
COS ANES FAT GRAF BILAL BREAS
|
Professional
|
Both
|
$310.00
|
|
| Hospital Charge Code |
37000219
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$217.00
|
| Rate for Payer: UHCCP Medicaid |
$108.50
|
|
|
COS ANES FAT GRAF BILAL BREAS
|
Facility
|
IP
|
$310.00
|
|
| Hospital Charge Code |
37000219
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
COS ANES FAT GRAF BILAL BREAS
|
Facility
|
OP
|
$310.00
|
|
| Hospital Charge Code |
37000219
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem Medicaid |
$106.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Humana KY Medicaid |
$106.61
|
| Rate for Payer: Kentucky WC Medicaid |
$107.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
COSEAL 4ML
|
Facility
|
OP
|
$4,040.56
|
|
| Hospital Charge Code |
25002967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,212.17 |
| Max. Negotiated Rate |
$3,878.94 |
| Rate for Payer: Aetna Commercial |
$3,111.23
|
| Rate for Payer: Anthem Medicaid |
$1,389.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,151.64
|
| Rate for Payer: Cash Price |
$2,020.28
|
| Rate for Payer: Cigna Commercial |
$3,353.66
|
| Rate for Payer: First Health Commercial |
$3,838.53
|
| Rate for Payer: Humana Commercial |
$3,434.48
|
| Rate for Payer: Humana KY Medicaid |
$1,389.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,403.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,313.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,981.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,212.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,417.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,555.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,030.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,232.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,515.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.99
|
| Rate for Payer: PHCS Commercial |
$3,878.94
|
| Rate for Payer: United Healthcare All Payer |
$3,555.69
|
|
|
COSEAL 4ML
|
Facility
|
IP
|
$4,040.56
|
|
| Hospital Charge Code |
25002967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,212.17 |
| Max. Negotiated Rate |
$3,878.94 |
| Rate for Payer: Aetna Commercial |
$3,111.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,151.64
|
| Rate for Payer: Cash Price |
$2,020.28
|
| Rate for Payer: Cigna Commercial |
$3,353.66
|
| Rate for Payer: First Health Commercial |
$3,838.53
|
| Rate for Payer: Humana Commercial |
$3,434.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,313.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,981.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,212.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,555.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,030.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,232.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,515.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.99
|
| Rate for Payer: PHCS Commercial |
$3,878.94
|
| Rate for Payer: United Healthcare All Payer |
$3,555.69
|
|
|
COSEAL SPRAY SET 0600021
|
Facility
|
IP
|
$836.25
|
|
| Hospital Charge Code |
25002967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$250.88 |
| Max. Negotiated Rate |
$802.80 |
| Rate for Payer: Aetna Commercial |
$643.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.27
|
| Rate for Payer: Cash Price |
$418.12
|
| Rate for Payer: Cigna Commercial |
$694.09
|
| Rate for Payer: First Health Commercial |
$794.44
|
| Rate for Payer: Humana Commercial |
$710.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.90
|
| Rate for Payer: Ohio Health Group HMO |
$627.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$669.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$577.01
|
| Rate for Payer: PHCS Commercial |
$802.80
|
| Rate for Payer: United Healthcare All Payer |
$735.90
|
|
