|
CYTP DX EVAL FNA 1ST EA SITE
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
30001423
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$158.33 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem Medicaid |
$158.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$221.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.33
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Humana KY Medicaid |
$158.33
|
| Rate for Payer: Humana Medicare Advantage |
$158.33
|
| Rate for Payer: Kentucky WC Medicaid |
$159.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.19
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
CYTP DX EVAL FNA 1ST EA SITE
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
30001423
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.19
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
D5%-0.2% Sod Chlor 1000mL
|
Facility
|
IP
|
$95.21
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004489
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$91.40 |
| Rate for Payer: Aetna Commercial |
$73.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.26
|
| Rate for Payer: Cash Price |
$47.60
|
| Rate for Payer: Cigna Commercial |
$79.02
|
| Rate for Payer: First Health Commercial |
$90.45
|
| Rate for Payer: Humana Commercial |
$80.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.78
|
| Rate for Payer: Ohio Health Group HMO |
$71.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.69
|
| Rate for Payer: PHCS Commercial |
$91.40
|
| Rate for Payer: United Healthcare All Payer |
$83.78
|
|
|
D5%-0.2% Sod Chlor 1000mL
|
Facility
|
OP
|
$95.21
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004489
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$91.40 |
| Rate for Payer: Aetna Commercial |
$73.31
|
| Rate for Payer: Anthem Medicaid |
$32.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.26
|
| Rate for Payer: Cash Price |
$47.60
|
| Rate for Payer: Cigna Commercial |
$79.02
|
| Rate for Payer: First Health Commercial |
$90.45
|
| Rate for Payer: Humana Commercial |
$80.93
|
| Rate for Payer: Humana KY Medicaid |
$32.74
|
| Rate for Payer: Kentucky WC Medicaid |
$33.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.78
|
| Rate for Payer: Ohio Health Group HMO |
$71.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.69
|
| Rate for Payer: PHCS Commercial |
$91.40
|
| Rate for Payer: United Healthcare All Payer |
$83.78
|
|
|
DABIGATRAN 75MG CAPSULE
|
Facility
|
OP
|
$11.31
|
|
|
Service Code
|
NDC 597035509
|
| Hospital Charge Code |
25000510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$10.86 |
| Rate for Payer: Aetna Commercial |
$8.71
|
| Rate for Payer: Anthem Medicaid |
$3.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.82
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cigna Commercial |
$9.39
|
| Rate for Payer: First Health Commercial |
$10.74
|
| Rate for Payer: Humana Commercial |
$9.61
|
| Rate for Payer: Humana KY Medicaid |
$3.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.95
|
| Rate for Payer: Ohio Health Group HMO |
$8.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.80
|
| Rate for Payer: PHCS Commercial |
$10.86
|
| Rate for Payer: United Healthcare All Payer |
$9.95
|
|
|
DABIGATRAN 75MG CAPSULE
|
Facility
|
IP
|
$11.31
|
|
|
Service Code
|
NDC 597035509
|
| Hospital Charge Code |
25000510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$10.86 |
| Rate for Payer: Aetna Commercial |
$8.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.82
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cigna Commercial |
$9.39
|
| Rate for Payer: First Health Commercial |
$10.74
|
| Rate for Payer: Humana Commercial |
$9.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.95
|
| Rate for Payer: Ohio Health Group HMO |
$8.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.80
|
| Rate for Payer: PHCS Commercial |
$10.86
|
| Rate for Payer: United Healthcare All Payer |
$9.95
|
|
|
DACARBAZINE 100MG
|
Facility
|
IP
|
$65.40
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
25002596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$62.78 |
| Rate for Payer: Aetna Commercial |
$50.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.01
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: First Health Commercial |
$62.13
|
| Rate for Payer: Humana Commercial |
$55.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.55
|
| Rate for Payer: Ohio Health Group HMO |
$49.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.13
|
| Rate for Payer: PHCS Commercial |
$62.78
|
| Rate for Payer: United Healthcare All Payer |
$57.55
|
|
|
DACARBAZINE 100MG
|
Facility
|
OP
|
$65.40
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
25002596
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$62.78 |
| Rate for Payer: Aetna Commercial |
$50.36
|
| Rate for Payer: Anthem Medicaid |
$22.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.01
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: First Health Commercial |
$62.13
|
| Rate for Payer: Humana Commercial |
$55.59
|
| Rate for Payer: Humana KY Medicaid |
$22.49
|
| Rate for Payer: Kentucky WC Medicaid |
$22.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.55
|
| Rate for Payer: Ohio Health Group HMO |
$49.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.13
|
| Rate for Payer: PHCS Commercial |
$62.78
|
| Rate for Payer: United Healthcare All Payer |
$57.55
|
|
|
DACARBAZINE 100MG VIAL
|
Facility
|
IP
|
$67.53
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
25002595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$64.83 |
| Rate for Payer: Aetna Commercial |
$52.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.67
|
| Rate for Payer: Cash Price |
$33.76
|
| Rate for Payer: Cigna Commercial |
$56.05
|
| Rate for Payer: First Health Commercial |
$64.15
|
| Rate for Payer: Humana Commercial |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.43
|
| Rate for Payer: Ohio Health Group HMO |
$50.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.60
|
| Rate for Payer: PHCS Commercial |
$64.83
|
| Rate for Payer: United Healthcare All Payer |
$59.43
|
|
|
DACARBAZINE 100MG VIAL
|
Facility
|
OP
|
$67.53
|
|
|
Service Code
|
HCPCS J9130
|
| Hospital Charge Code |
25002595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$64.83 |
| Rate for Payer: Aetna Commercial |
$52.00
|
| Rate for Payer: Anthem Medicaid |
$23.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.67
|
| Rate for Payer: Cash Price |
$33.76
|
| Rate for Payer: Cigna Commercial |
$56.05
|
| Rate for Payer: First Health Commercial |
$64.15
|
| Rate for Payer: Humana Commercial |
$57.40
|
| Rate for Payer: Humana KY Medicaid |
$23.22
|
| Rate for Payer: Kentucky WC Medicaid |
$23.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.43
|
| Rate for Payer: Ohio Health Group HMO |
$50.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.60
|
| Rate for Payer: PHCS Commercial |
$64.83
|
| Rate for Payer: United Healthcare All Payer |
$59.43
|
|
|
DACOGEN 1MG/0.2ML(50MG/10ML VL
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
25002000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.50 |
| Max. Negotiated Rate |
$523.20 |
| Rate for Payer: Aetna Commercial |
$419.65
|
| Rate for Payer: Anthem Medicaid |
$187.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.10
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$452.35
|
| Rate for Payer: First Health Commercial |
$517.75
|
| Rate for Payer: Humana Commercial |
$463.25
|
| Rate for Payer: Humana KY Medicaid |
$187.43
|
| Rate for Payer: Kentucky WC Medicaid |
$189.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.60
|
| Rate for Payer: Ohio Health Group HMO |
$408.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.05
|
| Rate for Payer: PHCS Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Payer |
$479.60
|
|
|
DACOGEN 1MG/0.2ML(50MG/10ML VL
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
25002000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.50 |
| Max. Negotiated Rate |
$523.20 |
| Rate for Payer: Aetna Commercial |
$419.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.10
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$452.35
|
| Rate for Payer: First Health Commercial |
$517.75
|
| Rate for Payer: Humana Commercial |
$463.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.60
|
| Rate for Payer: Ohio Health Group HMO |
$408.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$376.05
|
| Rate for Payer: PHCS Commercial |
$523.20
|
| Rate for Payer: United Healthcare All Payer |
$479.60
|
|
|
DACRIOSE IRRIG SOLUTION 4 4OZ
|
Facility
|
OP
|
$3.47
|
|
|
Service Code
|
NDC 10119000252
|
| Hospital Charge Code |
25002979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Anthem Medicaid |
$1.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.71
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cigna Commercial |
$2.88
|
| Rate for Payer: First Health Commercial |
$3.30
|
| Rate for Payer: Humana Commercial |
$2.95
|
| Rate for Payer: Humana KY Medicaid |
$1.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.05
|
| Rate for Payer: Ohio Health Group HMO |
$2.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.39
|
| Rate for Payer: PHCS Commercial |
$3.33
|
| Rate for Payer: United Healthcare All Payer |
$3.05
|
|
|
DACRIOSE IRRIG SOLUTION 4 4OZ
|
Facility
|
IP
|
$3.47
|
|
|
Service Code
|
NDC 10119000252
|
| Hospital Charge Code |
25002979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.71
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cigna Commercial |
$2.88
|
| Rate for Payer: First Health Commercial |
$3.30
|
| Rate for Payer: Humana Commercial |
$2.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.05
|
| Rate for Payer: Ohio Health Group HMO |
$2.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.39
|
| Rate for Payer: PHCS Commercial |
$3.33
|
| Rate for Payer: United Healthcare All Payer |
$3.05
|
|
|
DAILY POWER DEFENSE 50 ML GBL
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
22200144
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$51.59
|
| Rate for Payer: Kentucky WC Medicaid |
$52.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
DAILY POWER DEFENSE 50 ML GBL
|
Professional
|
Both
|
$150.00
|
|
| Hospital Charge Code |
22200144
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
|
|
DAILY POWER DEFENSE 50 ML GBL
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
22200144
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
DAKINS 1/2 STR [0.25%] S 480ML
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
NDC 39328006325
|
| Hospital Charge Code |
25002981
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna Commercial |
$1.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.08
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna Commercial |
$1.15
|
| Rate for Payer: First Health Commercial |
$1.32
|
| Rate for Payer: Humana Commercial |
$1.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.22
|
| Rate for Payer: Ohio Health Group HMO |
$1.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.96
|
| Rate for Payer: PHCS Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Payer |
$1.22
|
|
|
DAKINS 1/2 STR [0.25%] S 480ML
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
NDC 39328006325
|
| Hospital Charge Code |
25002981
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna Commercial |
$1.07
|
| Rate for Payer: Anthem Medicaid |
$0.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.08
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna Commercial |
$1.15
|
| Rate for Payer: First Health Commercial |
$1.32
|
| Rate for Payer: Humana Commercial |
$1.18
|
| Rate for Payer: Humana KY Medicaid |
$0.48
|
| Rate for Payer: Kentucky WC Medicaid |
$0.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.22
|
| Rate for Payer: Ohio Health Group HMO |
$1.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.96
|
| Rate for Payer: PHCS Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Payer |
$1.22
|
|
|
DALIRESP 500MCG TABLET
|
Facility
|
OP
|
$5.07
|
|
|
Service Code
|
NDC 68382096906
|
| Hospital Charge Code |
25000511
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Anthem Medicaid |
$1.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.95
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cigna Commercial |
$4.21
|
| Rate for Payer: First Health Commercial |
$4.82
|
| Rate for Payer: Humana Commercial |
$4.31
|
| Rate for Payer: Humana KY Medicaid |
$1.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.46
|
| Rate for Payer: Ohio Health Group HMO |
$3.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.50
|
| Rate for Payer: PHCS Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Payer |
$4.46
|
|
|
DALIRESP 500MCG TABLET
|
Facility
|
IP
|
$5.07
|
|
|
Service Code
|
NDC 68382096906
|
| Hospital Charge Code |
25000511
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.95
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cigna Commercial |
$4.21
|
| Rate for Payer: First Health Commercial |
$4.82
|
| Rate for Payer: Humana Commercial |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.46
|
| Rate for Payer: Ohio Health Group HMO |
$3.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.50
|
| Rate for Payer: PHCS Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Payer |
$4.46
|
|
|
DALL-MILES GRIP W/ 2 CBL MED 1
|
Facility
|
OP
|
$11,254.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.30 |
| Max. Negotiated Rate |
$10,804.17 |
| Rate for Payer: Aetna Commercial |
$8,665.84
|
| Rate for Payer: Anthem Medicaid |
$3,870.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,778.39
|
| Rate for Payer: Cash Price |
$5,627.17
|
| Rate for Payer: Cigna Commercial |
$9,341.10
|
| Rate for Payer: First Health Commercial |
$10,691.62
|
| Rate for Payer: Humana Commercial |
$9,566.19
|
| Rate for Payer: Humana KY Medicaid |
$3,870.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,909.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,228.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,305.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,948.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,903.82
|
| Rate for Payer: Ohio Health Group HMO |
$8,440.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,003.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,791.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,765.49
|
| Rate for Payer: PHCS Commercial |
$10,804.17
|
| Rate for Payer: United Healthcare All Payer |
$9,903.82
|
|
|
DALL-MILES GRIP W/ 2 CBL MED 1
|
Facility
|
IP
|
$11,254.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.30 |
| Max. Negotiated Rate |
$10,804.17 |
| Rate for Payer: Aetna Commercial |
$8,665.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,778.39
|
| Rate for Payer: Cash Price |
$5,627.17
|
| Rate for Payer: Cigna Commercial |
$9,341.10
|
| Rate for Payer: First Health Commercial |
$10,691.62
|
| Rate for Payer: Humana Commercial |
$9,566.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,228.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,305.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,376.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,903.82
|
| Rate for Payer: Ohio Health Group HMO |
$8,440.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,003.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,791.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,765.49
|
| Rate for Payer: PHCS Commercial |
$10,804.17
|
| Rate for Payer: United Healthcare All Payer |
$9,903.82
|
|
|
DALL-MILES GRP W/2 CBL M 100MM
|
Facility
|
IP
|
$7,745.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.64 |
| Max. Negotiated Rate |
$7,435.65 |
| Rate for Payer: Aetna Commercial |
$5,964.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.47
|
| Rate for Payer: Cash Price |
$3,872.74
|
| Rate for Payer: Cigna Commercial |
$6,428.74
|
| Rate for Payer: First Health Commercial |
$7,358.20
|
| Rate for Payer: Humana Commercial |
$6,583.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,351.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,716.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,816.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,809.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.37
|
| Rate for Payer: PHCS Commercial |
$7,435.65
|
| Rate for Payer: United Healthcare All Payer |
$6,816.01
|
|
|
DALL-MILES GRP W/2 CBL M 100MM
|
Facility
|
OP
|
$7,745.47
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.64 |
| Max. Negotiated Rate |
$7,435.65 |
| Rate for Payer: Aetna Commercial |
$5,964.01
|
| Rate for Payer: Anthem Medicaid |
$2,663.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.47
|
| Rate for Payer: Cash Price |
$3,872.74
|
| Rate for Payer: Cigna Commercial |
$6,428.74
|
| Rate for Payer: First Health Commercial |
$7,358.20
|
| Rate for Payer: Humana Commercial |
$6,583.65
|
| Rate for Payer: Humana KY Medicaid |
$2,663.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,351.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,716.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,717.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,816.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,809.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.37
|
| Rate for Payer: PHCS Commercial |
$7,435.65
|
| Rate for Payer: United Healthcare All Payer |
$6,816.01
|
|
