|
DICLOXACILLIN 500MG CAPSULE
|
Facility
|
OP
|
$9.37
|
|
|
Service Code
|
NDC 93312501
|
| Hospital Charge Code |
25000556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: Anthem Medicaid |
$3.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.31
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna Commercial |
$7.78
|
| Rate for Payer: First Health Commercial |
$8.90
|
| Rate for Payer: Humana Commercial |
$7.96
|
| Rate for Payer: Humana KY Medicaid |
$3.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.25
|
| Rate for Payer: Ohio Health Group HMO |
$7.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Payer |
$8.25
|
|
|
DICLOXACILLIN 500MG CAPSULE
|
Facility
|
IP
|
$9.37
|
|
|
Service Code
|
NDC 93312501
|
| Hospital Charge Code |
25000556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.31
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna Commercial |
$7.78
|
| Rate for Payer: First Health Commercial |
$8.90
|
| Rate for Payer: Humana Commercial |
$7.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.25
|
| Rate for Payer: Ohio Health Group HMO |
$7.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Payer |
$8.25
|
|
|
DIFFERENTIAL ADSORPTION SERUM
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 86978
|
| Hospital Charge Code |
30001244
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem Medicaid |
$31.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Humana KY Medicaid |
$31.29
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$31.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.21
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
DIFFERENTIAL ADSORPTION SERUM
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 86978
|
| Hospital Charge Code |
30001244
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.07
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cigna Commercial |
$75.53
|
| Rate for Payer: First Health Commercial |
$86.45
|
| Rate for Payer: Humana Commercial |
$77.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.08
|
| Rate for Payer: Ohio Health Group HMO |
$68.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.21
|
| Rate for Payer: PHCS Commercial |
$87.36
|
| Rate for Payer: United Healthcare All Payer |
$80.08
|
|
|
Dificid 200mg/5mL Susp 5mL
|
Facility
|
OP
|
$354.47
|
|
|
Service Code
|
NDC 52015070022
|
| Hospital Charge Code |
25004135
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$340.29 |
| Rate for Payer: Aetna Commercial |
$272.94
|
| Rate for Payer: Anthem Medicaid |
$121.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.49
|
| Rate for Payer: Cash Price |
$177.24
|
| Rate for Payer: Cigna Commercial |
$294.21
|
| Rate for Payer: First Health Commercial |
$336.75
|
| Rate for Payer: Humana Commercial |
$301.30
|
| Rate for Payer: Humana KY Medicaid |
$121.90
|
| Rate for Payer: Kentucky WC Medicaid |
$123.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.93
|
| Rate for Payer: Ohio Health Group HMO |
$265.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.89
|
| Rate for Payer: PHCS Commercial |
$340.29
|
| Rate for Payer: United Healthcare All Payer |
$311.93
|
|
|
Dificid 200mg/5mL Susp 5mL
|
Facility
|
IP
|
$354.47
|
|
|
Service Code
|
NDC 52015070022
|
| Hospital Charge Code |
25004135
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$340.29 |
| Rate for Payer: Aetna Commercial |
$272.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.49
|
| Rate for Payer: Cash Price |
$177.24
|
| Rate for Payer: Cigna Commercial |
$294.21
|
| Rate for Payer: First Health Commercial |
$336.75
|
| Rate for Payer: Humana Commercial |
$301.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.93
|
| Rate for Payer: Ohio Health Group HMO |
$265.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.89
|
| Rate for Payer: PHCS Commercial |
$340.29
|
| Rate for Payer: United Healthcare All Payer |
$311.93
|
|
|
DIFICID 200MG TABLET
|
Facility
|
OP
|
$419.04
|
|
|
Service Code
|
NDC 52015008001
|
| Hospital Charge Code |
25000558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$402.28 |
| Rate for Payer: Aetna Commercial |
$322.66
|
| Rate for Payer: Anthem Medicaid |
$144.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.85
|
| Rate for Payer: Cash Price |
$209.52
|
| Rate for Payer: Cigna Commercial |
$347.80
|
| Rate for Payer: First Health Commercial |
$398.09
|
| Rate for Payer: Humana Commercial |
$356.18
|
| Rate for Payer: Humana KY Medicaid |
$144.11
|
| Rate for Payer: Kentucky WC Medicaid |
$145.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$343.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$368.76
|
| Rate for Payer: Ohio Health Group HMO |
$314.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.90
|
| Rate for Payer: PHCS Commercial |
$402.28
|
| Rate for Payer: United Healthcare All Payer |
$368.76
|
|
|
DIFICID 200MG TABLET
|
Facility
|
IP
|
$419.04
|
|
|
Service Code
|
NDC 52015008001
|
| Hospital Charge Code |
25000558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$402.28 |
| Rate for Payer: Aetna Commercial |
$322.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.85
|
| Rate for Payer: Cash Price |
$209.52
|
| Rate for Payer: Cigna Commercial |
$347.80
|
| Rate for Payer: First Health Commercial |
$398.09
|
| Rate for Payer: Humana Commercial |
$356.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$343.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$368.76
|
| Rate for Payer: Ohio Health Group HMO |
$314.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.90
|
| Rate for Payer: PHCS Commercial |
$402.28
|
| Rate for Payer: United Healthcare All Payer |
$368.76
|
|
|
DIFLUCAN 200MG/100ML BOTTLE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
25002063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem Medicaid |
$39.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.48
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Humana KY Medicaid |
$39.89
|
| Rate for Payer: Kentucky WC Medicaid |
$40.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
DIFLUCAN 200MG/100ML BOTTLE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS J1450
|
| Hospital Charge Code |
25002063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.48
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
DIFLUCAN (FLUCONAZO 100MG/1TAB
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
NDC 68001025204
|
| Hospital Charge Code |
25000559
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem Medicaid |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.41
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.02
|
| Rate for Payer: Humana Commercial |
$8.08
|
| Rate for Payer: Humana KY Medicaid |
$3.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.36
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Payer |
$8.36
|
|
|
DIFLUCAN (FLUCONAZO 100MG/1TAB
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
NDC 68001025204
|
| Hospital Charge Code |
25000559
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.41
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna Commercial |
$7.88
|
| Rate for Payer: First Health Commercial |
$9.02
|
| Rate for Payer: Humana Commercial |
$8.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.36
|
| Rate for Payer: Ohio Health Group HMO |
$7.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$9.12
|
| Rate for Payer: United Healthcare All Payer |
$8.36
|
|
|
DIFLUCAN (FLUCONAZOLE) 200MG T
|
Facility
|
OP
|
$4.87
|
|
|
Service Code
|
NDC 57237000630
|
| Hospital Charge Code |
25000560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.04
|
| Rate for Payer: First Health Commercial |
$4.63
|
| Rate for Payer: Humana Commercial |
$4.14
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
DIFLUCAN (FLUCONAZOLE) 200MG T
|
Facility
|
IP
|
$4.87
|
|
|
Service Code
|
NDC 57237000630
|
| Hospital Charge Code |
25000560
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Humana Commercial |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.04
|
| Rate for Payer: First Health Commercial |
$4.63
|
|
|
DIFLUCAN(FLUCONAZOLE) 50MG TAB
|
Facility
|
OP
|
$9.12
|
|
|
Service Code
|
NDC 68001025104
|
| Hospital Charge Code |
25000562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Aetna Commercial |
$7.02
|
| Rate for Payer: Anthem Medicaid |
$3.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.11
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cigna Commercial |
$7.57
|
| Rate for Payer: First Health Commercial |
$8.66
|
| Rate for Payer: Humana Commercial |
$7.75
|
| Rate for Payer: Humana KY Medicaid |
$3.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.03
|
| Rate for Payer: Ohio Health Group HMO |
$6.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.83
|
| Rate for Payer: PHCS Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Payer |
$8.03
|
|
|
DIFLUCAN(FLUCONAZOLE) 50MG TAB
|
Facility
|
IP
|
$9.12
|
|
|
Service Code
|
NDC 68001025104
|
| Hospital Charge Code |
25000562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Aetna Commercial |
$7.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.11
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cigna Commercial |
$7.57
|
| Rate for Payer: First Health Commercial |
$8.66
|
| Rate for Payer: Humana Commercial |
$7.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.03
|
| Rate for Payer: Ohio Health Group HMO |
$6.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.83
|
| Rate for Payer: PHCS Commercial |
$8.76
|
| Rate for Payer: United Healthcare All Payer |
$8.03
|
|
|
DIGESTIVE MALIGNANCY WITH CC
|
Facility
|
IP
|
$14,017.95
|
|
|
Service Code
|
MSDRG 375
|
| Min. Negotiated Rate |
$9,512.18 |
| Max. Negotiated Rate |
$14,017.95 |
| Rate for Payer: Anthem Medicaid |
$9,512.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,012.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,017.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,517.31
|
| Rate for Payer: Humana KY Medicaid |
$9,512.18
|
| Rate for Payer: Humana Medicare Advantage |
$10,012.82
|
| Rate for Payer: Kentucky WC Medicaid |
$9,607.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,015.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,702.42
|
|
|
DIGESTIVE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$24,554.54
|
|
|
Service Code
|
MSDRG 374
|
| Min. Negotiated Rate |
$16,662.01 |
| Max. Negotiated Rate |
$24,554.54 |
| Rate for Payer: Anthem Medicaid |
$16,662.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,538.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,554.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,677.60
|
| Rate for Payer: Humana KY Medicaid |
$16,662.01
|
| Rate for Payer: Humana Medicare Advantage |
$17,538.96
|
| Rate for Payer: Kentucky WC Medicaid |
$16,828.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,046.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,995.25
|
|
|
DIGESTIVE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$10,427.76
|
|
|
Service Code
|
MSDRG 376
|
| Min. Negotiated Rate |
$7,075.98 |
| Max. Negotiated Rate |
$10,427.76 |
| Rate for Payer: Anthem Medicaid |
$7,075.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,448.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,427.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,055.34
|
| Rate for Payer: Humana KY Medicaid |
$7,075.98
|
| Rate for Payer: Humana Medicare Advantage |
$7,448.40
|
| Rate for Payer: Kentucky WC Medicaid |
$7,146.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,938.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,217.50
|
|
|
DIGIAL PROSTATE EXAM
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS G0102
|
| Hospital Charge Code |
51000132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.40
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$24.90
|
| Rate for Payer: First Health Commercial |
$28.50
|
| Rate for Payer: Humana Commercial |
$25.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.40
|
| Rate for Payer: Ohio Health Group HMO |
$22.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.30
|
| Rate for Payer: PHCS Commercial |
$28.80
|
| Rate for Payer: United Healthcare All Payer |
$26.40
|
|
|
DIGIAL PROSTATE EXAM
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS G0102
|
| Hospital Charge Code |
51000132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.49
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.00
|
| Rate for Payer: UHCCP Medicaid |
$10.50
|
|
|
DIGIAL PROSTATE EXAM
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS G0102
|
| Hospital Charge Code |
51000132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Anthem Medicaid |
$10.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.40
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$24.90
|
| Rate for Payer: First Health Commercial |
$28.50
|
| Rate for Payer: Humana Commercial |
$25.50
|
| Rate for Payer: Humana KY Medicaid |
$10.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.40
|
| Rate for Payer: Ohio Health Group HMO |
$22.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.30
|
| Rate for Payer: PHCS Commercial |
$28.80
|
| Rate for Payer: United Healthcare All Payer |
$26.40
|
|
|
DIGIFAB [1 VIAL] 40MG VIAL
|
Facility
|
OP
|
$6,533.00
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
25002021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$849.29 |
| Max. Negotiated Rate |
$6,688.42 |
| Rate for Payer: Aetna Commercial |
$5,030.41
|
| Rate for Payer: Anthem Medicaid |
$2,246.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,777.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,095.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,688.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,449.55
|
| Rate for Payer: Cash Price |
$3,266.50
|
| Rate for Payer: Cash Price |
$3,266.50
|
| Rate for Payer: Cigna Commercial |
$5,422.39
|
| Rate for Payer: First Health Commercial |
$6,206.35
|
| Rate for Payer: Humana Commercial |
$5,553.05
|
| Rate for Payer: Humana KY Medicaid |
$2,246.70
|
| Rate for Payer: Humana Medicare Advantage |
$4,777.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,269.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,821.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,732.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,291.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,749.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,899.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,306.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.23
|
| Rate for Payer: PHCS Commercial |
$6,271.68
|
| Rate for Payer: United Healthcare All Payer |
$5,749.04
|
|
|
DIGIFAB [1 VIAL] 40MG VIAL
|
Facility
|
IP
|
$6,533.00
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
25002021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$849.29 |
| Max. Negotiated Rate |
$6,271.68 |
| Rate for Payer: Humana Commercial |
$5,553.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,821.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,959.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,749.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,899.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,306.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.23
|
| Rate for Payer: PHCS Commercial |
$6,271.68
|
| Rate for Payer: United Healthcare All Payer |
$5,749.04
|
| Rate for Payer: Aetna Commercial |
$5,030.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,095.74
|
| Rate for Payer: Cash Price |
$3,266.50
|
| Rate for Payer: Cigna Commercial |
$5,422.39
|
| Rate for Payer: First Health Commercial |
$6,206.35
|
|
|
DIGOXIN
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
30000025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.22
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
