|
ALOXI 0.025MG (0.25MG/5ML VL)
|
Facility
|
IP
|
$272.50
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
25002303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$261.60 |
| Rate for Payer: Aetna Commercial |
$209.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.55
|
| Rate for Payer: Cash Price |
$136.25
|
| Rate for Payer: Cigna Commercial |
$226.18
|
| Rate for Payer: First Health Commercial |
$258.88
|
| Rate for Payer: Humana Commercial |
$231.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.80
|
| Rate for Payer: Ohio Health Group HMO |
$204.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.48
|
| Rate for Payer: PHCS Commercial |
$261.60
|
| Rate for Payer: United Healthcare All Payer |
$239.80
|
|
|
ALOXI 0.025MG (0.25MG/5ML VL)
|
Facility
|
OP
|
$272.50
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
25002303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$261.60 |
| Rate for Payer: Aetna Commercial |
$209.82
|
| Rate for Payer: Anthem Medicaid |
$93.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.55
|
| Rate for Payer: Cash Price |
$136.25
|
| Rate for Payer: Cigna Commercial |
$226.18
|
| Rate for Payer: First Health Commercial |
$258.88
|
| Rate for Payer: Humana Commercial |
$231.62
|
| Rate for Payer: Humana KY Medicaid |
$93.71
|
| Rate for Payer: Kentucky WC Medicaid |
$94.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.80
|
| Rate for Payer: Ohio Health Group HMO |
$204.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.48
|
| Rate for Payer: PHCS Commercial |
$261.60
|
| Rate for Payer: United Healthcare All Payer |
$239.80
|
|
|
ALPHAGAN 0.15% EYE DROPS
|
Facility
|
IP
|
$5.71
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
25000197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$5.48 |
| Rate for Payer: Aetna Commercial |
$4.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.45
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cigna Commercial |
$4.74
|
| Rate for Payer: First Health Commercial |
$5.42
|
| Rate for Payer: Humana Commercial |
$4.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.02
|
| Rate for Payer: Ohio Health Group HMO |
$4.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.77
|
| Rate for Payer: PHCS Commercial |
$5.48
|
| Rate for Payer: United Healthcare All Payer |
$5.02
|
|
|
ALPHAGAN 0.15% EYE DROPS
|
Facility
|
OP
|
$5.71
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
25000197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$5.48 |
| Rate for Payer: Aetna Commercial |
$4.40
|
| Rate for Payer: Anthem Medicaid |
$1.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.45
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cigna Commercial |
$4.74
|
| Rate for Payer: First Health Commercial |
$5.42
|
| Rate for Payer: Humana Commercial |
$4.85
|
| Rate for Payer: Humana KY Medicaid |
$1.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.02
|
| Rate for Payer: Ohio Health Group HMO |
$4.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.77
|
| Rate for Payer: PHCS Commercial |
$5.48
|
| Rate for Payer: United Healthcare All Payer |
$5.02
|
|
|
ALPHAGAN P 0.1% 5ML
|
Facility
|
IP
|
$6.12
|
|
|
Service Code
|
NDC 23932105
|
| Hospital Charge Code |
25000199
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$5.88 |
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.77
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cigna Commercial |
$5.08
|
| Rate for Payer: First Health Commercial |
$5.81
|
| Rate for Payer: Humana Commercial |
$5.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.39
|
| Rate for Payer: Ohio Health Group HMO |
$4.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.90
|
| Rate for Payer: PHCS Commercial |
$5.88
|
| Rate for Payer: United Healthcare All Payer |
$5.39
|
|
|
ALPHAGAN P 0.1% 5ML
|
Facility
|
OP
|
$6.12
|
|
|
Service Code
|
NDC 23932105
|
| Hospital Charge Code |
25000199
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$5.88 |
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Anthem Medicaid |
$2.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.77
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cigna Commercial |
$5.08
|
| Rate for Payer: First Health Commercial |
$5.81
|
| Rate for Payer: Humana Commercial |
$5.20
|
| Rate for Payer: Humana KY Medicaid |
$2.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.39
|
| Rate for Payer: Ohio Health Group HMO |
$4.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.90
|
| Rate for Payer: PHCS Commercial |
$5.88
|
| Rate for Payer: United Healthcare All Payer |
$5.39
|
|
|
ALPROSTADIL 1.25mcg(20mcg SDV)
|
Facility
|
OP
|
$572.30
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25004492
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$549.41 |
| Rate for Payer: Aetna Commercial |
$440.67
|
| Rate for Payer: Anthem Medicaid |
$196.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.39
|
| Rate for Payer: Cash Price |
$286.15
|
| Rate for Payer: Cigna Commercial |
$475.01
|
| Rate for Payer: First Health Commercial |
$543.68
|
| Rate for Payer: Humana Commercial |
$486.46
|
| Rate for Payer: Humana KY Medicaid |
$196.81
|
| Rate for Payer: Kentucky WC Medicaid |
$198.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$200.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$503.62
|
| Rate for Payer: Ohio Health Group HMO |
$429.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.41
|
| Rate for Payer: PHCS Commercial |
$549.41
|
| Rate for Payer: United Healthcare All Payer |
$503.62
|
|
|
ALPROSTADIL 1.25mcg(20mcg SDV)
|
Facility
|
IP
|
$572.30
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25004492
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$549.41 |
| Rate for Payer: Aetna Commercial |
$440.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.39
|
| Rate for Payer: Cash Price |
$286.15
|
| Rate for Payer: Cigna Commercial |
$475.01
|
| Rate for Payer: First Health Commercial |
$543.68
|
| Rate for Payer: Humana Commercial |
$486.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$503.62
|
| Rate for Payer: Ohio Health Group HMO |
$429.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.41
|
| Rate for Payer: PHCS Commercial |
$549.41
|
| Rate for Payer: United Healthcare All Payer |
$503.62
|
|
|
ALPROSTADIL 1.25mcg(40mcg SDV)
|
Facility
|
IP
|
$747.47
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25004268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.17 |
| Max. Negotiated Rate |
$717.57 |
| Rate for Payer: Aetna Commercial |
$575.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.03
|
| Rate for Payer: Cash Price |
$373.74
|
| Rate for Payer: Cigna Commercial |
$620.40
|
| Rate for Payer: First Health Commercial |
$710.10
|
| Rate for Payer: Humana Commercial |
$635.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$612.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$551.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$657.77
|
| Rate for Payer: Ohio Health Group HMO |
$560.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.72
|
| Rate for Payer: PHCS Commercial |
$717.57
|
| Rate for Payer: United Healthcare All Payer |
$657.77
|
|
|
ALPROSTADIL 1.25mcg(40mcg SDV)
|
Facility
|
OP
|
$747.47
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
25004268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.17 |
| Max. Negotiated Rate |
$717.57 |
| Rate for Payer: Aetna Commercial |
$575.55
|
| Rate for Payer: Anthem Medicaid |
$257.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.03
|
| Rate for Payer: Cash Price |
$373.74
|
| Rate for Payer: Cigna Commercial |
$620.40
|
| Rate for Payer: First Health Commercial |
$710.10
|
| Rate for Payer: Humana Commercial |
$635.35
|
| Rate for Payer: Humana KY Medicaid |
$257.05
|
| Rate for Payer: Kentucky WC Medicaid |
$259.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$612.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$551.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$657.77
|
| Rate for Payer: Ohio Health Group HMO |
$560.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.72
|
| Rate for Payer: PHCS Commercial |
$717.57
|
| Rate for Payer: United Healthcare All Payer |
$657.77
|
|
|
ALTACE RAMIPRIL 1.25MG CAP
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 68382014406
|
| Hospital Charge Code |
25000202
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
ALTACE RAMIPRIL 1.25MG CAP
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 68382014406
|
| Hospital Charge Code |
25000202
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
ALTACE (RAMIPRIL) 2.5MG/1CAP
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
25000200
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
ALTACE (RAMIPRIL) 2.5MG/1CAP
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
25000200
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
ALTACE (RAMIPRIL) 5MG/1CAP
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
25000201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
ALTACE (RAMIPRIL) 5MG/1CAP
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
25000201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
ALTERNARIA TENUIS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000794
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
ALTERNARIA TENUIS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000794
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
ALTRX +4 10D LNR 32 X 48
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
ALTRX +4 10D LNR 32 X 48
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
ALTRX +4 10D LNR 32 X 50
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
ALTRX +4 10D LNR 32 X 50
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
ALTRX +4 10D LNR 32 X 52
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
ALTRX +4 10D LNR 32 X 52
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
ALTRX +4 10D LNR 32 X 54
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
