|
EPIPEN JR 0.15mg Syringe
|
Facility
|
OP
|
$1,658.49
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004360
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$497.55 |
| Max. Negotiated Rate |
$1,592.15 |
| Rate for Payer: Aetna Commercial |
$1,277.04
|
| Rate for Payer: Anthem Medicaid |
$570.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,293.62
|
| Rate for Payer: Cash Price |
$829.24
|
| Rate for Payer: Cigna Commercial |
$1,376.55
|
| Rate for Payer: First Health Commercial |
$1,575.57
|
| Rate for Payer: Humana Commercial |
$1,409.72
|
| Rate for Payer: Humana KY Medicaid |
$570.35
|
| Rate for Payer: Kentucky WC Medicaid |
$576.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,359.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,223.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$497.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$581.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,459.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,243.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,442.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,144.36
|
| Rate for Payer: PHCS Commercial |
$1,592.15
|
| Rate for Payer: United Healthcare All Payer |
$1,459.47
|
|
|
EPIPEN JR 0.15mg Syringe
|
Facility
|
IP
|
$1,658.49
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004360
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$497.55 |
| Max. Negotiated Rate |
$1,592.15 |
| Rate for Payer: Aetna Commercial |
$1,277.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,293.62
|
| Rate for Payer: Cash Price |
$829.24
|
| Rate for Payer: Cigna Commercial |
$1,376.55
|
| Rate for Payer: First Health Commercial |
$1,575.57
|
| Rate for Payer: Humana Commercial |
$1,409.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,359.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,223.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$497.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,459.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,243.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,442.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,144.36
|
| Rate for Payer: PHCS Commercial |
$1,592.15
|
| Rate for Payer: United Healthcare All Payer |
$1,459.47
|
|
|
EPIRUBICIN 2MG (50 MG/25 ML) C
|
Facility
|
OP
|
$262.09
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
25002609
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.63 |
| Max. Negotiated Rate |
$251.61 |
| Rate for Payer: Aetna Commercial |
$201.81
|
| Rate for Payer: Anthem Medicaid |
$90.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.43
|
| Rate for Payer: Cash Price |
$131.04
|
| Rate for Payer: Cigna Commercial |
$217.53
|
| Rate for Payer: First Health Commercial |
$248.99
|
| Rate for Payer: Humana Commercial |
$222.78
|
| Rate for Payer: Humana KY Medicaid |
$90.13
|
| Rate for Payer: Kentucky WC Medicaid |
$91.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$193.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$230.64
|
| Rate for Payer: Ohio Health Group HMO |
$196.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$209.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.84
|
| Rate for Payer: PHCS Commercial |
$251.61
|
| Rate for Payer: United Healthcare All Payer |
$230.64
|
|
|
EPIRUBICIN 2MG (50 MG/25 ML) C
|
Facility
|
IP
|
$262.09
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
25002609
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.63 |
| Max. Negotiated Rate |
$251.61 |
| Rate for Payer: Aetna Commercial |
$201.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.43
|
| Rate for Payer: Cash Price |
$131.04
|
| Rate for Payer: Cigna Commercial |
$217.53
|
| Rate for Payer: First Health Commercial |
$248.99
|
| Rate for Payer: Humana Commercial |
$222.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$193.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$230.64
|
| Rate for Payer: Ohio Health Group HMO |
$196.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$209.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.84
|
| Rate for Payer: PHCS Commercial |
$251.61
|
| Rate for Payer: United Healthcare All Payer |
$230.64
|
|
|
EPISIOTOMY OR VAGINAL REPAI(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
720P0013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$244.30 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Ambetter Exchange |
$140.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.92
|
| Rate for Payer: Anthem Medicaid |
$99.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$140.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$140.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$168.74
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$220.05
|
| Rate for Payer: Healthspan PPO |
$225.04
|
| Rate for Payer: Humana Medicaid |
$99.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$140.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.69
|
| Rate for Payer: Molina Healthcare Passport |
$99.70
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.81
|
| Rate for Payer: UHCCP Medicaid |
$78.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.62
|
|
|
EPISIOTOMY OR VAGINAL REPAIR
|
Facility
|
IP
|
$4,081.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
72000013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,224.30 |
| Max. Negotiated Rate |
$3,917.76 |
| Rate for Payer: Aetna Commercial |
$3,142.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,183.18
|
| Rate for Payer: Cash Price |
$2,040.50
|
| Rate for Payer: Cigna Commercial |
$3,387.23
|
| Rate for Payer: First Health Commercial |
$3,876.95
|
| Rate for Payer: Humana Commercial |
$3,468.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,346.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,011.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,591.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,060.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,550.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,815.89
|
| Rate for Payer: PHCS Commercial |
$3,917.76
|
| Rate for Payer: United Healthcare All Payer |
$3,591.28
|
|
|
EPISIOTOMY OR VAGINAL REPAIR
|
Professional
|
Both
|
$4,081.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
72000013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$2,448.60 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Ambetter Exchange |
$140.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.92
|
| Rate for Payer: Anthem Medicaid |
$99.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$140.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$140.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$168.74
|
| Rate for Payer: Cash Price |
$2,040.50
|
| Rate for Payer: Cash Price |
$2,040.50
|
| Rate for Payer: Cigna Commercial |
$220.05
|
| Rate for Payer: Healthspan PPO |
$225.04
|
| Rate for Payer: Humana Medicaid |
$99.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$140.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.69
|
| Rate for Payer: Molina Healthcare Passport |
$99.70
|
| Rate for Payer: Multiplan PHCS |
$2,448.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.81
|
| Rate for Payer: UHCCP Medicaid |
$78.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.62
|
|
|
EPISIOTOMY OR VAGINAL REPAIR
|
Facility
|
OP
|
$4,081.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
72000013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,403.46 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$3,142.37
|
| Rate for Payer: Anthem Medicaid |
$1,403.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,183.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$2,040.50
|
| Rate for Payer: Cash Price |
$2,040.50
|
| Rate for Payer: Cigna Commercial |
$3,387.23
|
| Rate for Payer: First Health Commercial |
$3,876.95
|
| Rate for Payer: Humana Commercial |
$3,468.85
|
| Rate for Payer: Humana KY Medicaid |
$1,403.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,417.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,346.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,011.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,431.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,591.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,060.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,550.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,815.89
|
| Rate for Payer: PHCS Commercial |
$3,917.76
|
| Rate for Payer: United Healthcare All Payer |
$3,591.28
|
|
|
EPISIOTOMY OR VAGINAL REPAI(T
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
720T0013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,119.30 |
| Max. Negotiated Rate |
$3,581.76 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,574.39
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
EPISIOTOMY OR VAGINAL REPAI(T
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
720T0013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,283.09 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem Medicaid |
$1,283.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Humana KY Medicaid |
$1,283.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,574.39
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
EPIVAR(LAMIVUDINE)150MG/1TAB
|
Facility
|
IP
|
$28.72
|
|
|
Service Code
|
NDC 60505325006
|
| Hospital Charge Code |
25000625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$27.57 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.40
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cigna Commercial |
$23.84
|
| Rate for Payer: First Health Commercial |
$27.28
|
| Rate for Payer: Humana Commercial |
$24.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.27
|
| Rate for Payer: Ohio Health Group HMO |
$21.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.82
|
| Rate for Payer: PHCS Commercial |
$27.57
|
| Rate for Payer: United Healthcare All Payer |
$25.27
|
|
|
EPIVAR(LAMIVUDINE)150MG/1TAB
|
Facility
|
IP
|
$5.03
|
|
|
Service Code
|
NDC 33342000109
|
| Hospital Charge Code |
25000625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.47
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
EPIVAR(LAMIVUDINE)150MG/1TAB
|
Facility
|
OP
|
$28.72
|
|
|
Service Code
|
NDC 60505325006
|
| Hospital Charge Code |
25000625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$27.57 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Anthem Medicaid |
$9.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.40
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cigna Commercial |
$23.84
|
| Rate for Payer: First Health Commercial |
$27.28
|
| Rate for Payer: Humana Commercial |
$24.41
|
| Rate for Payer: Humana KY Medicaid |
$9.88
|
| Rate for Payer: Kentucky WC Medicaid |
$9.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.27
|
| Rate for Payer: Ohio Health Group HMO |
$21.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.82
|
| Rate for Payer: PHCS Commercial |
$27.57
|
| Rate for Payer: United Healthcare All Payer |
$25.27
|
|
|
EPIVAR(LAMIVUDINE)150MG/1TAB
|
Facility
|
OP
|
$5.03
|
|
|
Service Code
|
NDC 33342000109
|
| Hospital Charge Code |
25000625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.47
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
EPLEY MANEUVER
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 95992
|
| Hospital Charge Code |
42000004
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
EPLEY MANEUVER
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 95992
|
| Hospital Charge Code |
42000004
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$40.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$40.24
|
| Rate for Payer: Kentucky WC Medicaid |
$40.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.73
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
EPLVIR 300MG EQUIV TABLET
|
Facility
|
OP
|
$9.67
|
|
|
Service Code
|
NDC 33342000207
|
| Hospital Charge Code |
25003046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Anthem Medicaid |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.54
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna Commercial |
$8.03
|
| Rate for Payer: First Health Commercial |
$9.19
|
| Rate for Payer: Humana Commercial |
$8.22
|
| Rate for Payer: Humana KY Medicaid |
$3.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.51
|
| Rate for Payer: Ohio Health Group HMO |
$7.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.67
|
| Rate for Payer: PHCS Commercial |
$9.28
|
| Rate for Payer: United Healthcare All Payer |
$8.51
|
|
|
EPLVIR 300MG EQUIV TABLET
|
Facility
|
IP
|
$9.67
|
|
|
Service Code
|
NDC 33342000207
|
| Hospital Charge Code |
25003046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.54
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna Commercial |
$8.03
|
| Rate for Payer: First Health Commercial |
$9.19
|
| Rate for Payer: Humana Commercial |
$8.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.51
|
| Rate for Payer: Ohio Health Group HMO |
$7.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.67
|
| Rate for Payer: PHCS Commercial |
$9.28
|
| Rate for Payer: United Healthcare All Payer |
$8.51
|
|
|
EPOPROSTENOL 0.5MG (1.5mg SDV)
|
Facility
|
OP
|
$200.50
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
25002050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.15 |
| Max. Negotiated Rate |
$192.48 |
| Rate for Payer: Aetna Commercial |
$154.38
|
| Rate for Payer: Aetna Commercial |
$154.88
|
| Rate for Payer: Anthem Medicaid |
$68.95
|
| Rate for Payer: Anthem Medicaid |
$69.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.89
|
| Rate for Payer: Cash Price |
$100.25
|
| Rate for Payer: Cash Price |
$100.57
|
| Rate for Payer: Cigna Commercial |
$166.95
|
| Rate for Payer: Cigna Commercial |
$166.41
|
| Rate for Payer: First Health Commercial |
$191.08
|
| Rate for Payer: First Health Commercial |
$190.47
|
| Rate for Payer: Humana Commercial |
$170.43
|
| Rate for Payer: Humana Commercial |
$170.97
|
| Rate for Payer: Humana KY Medicaid |
$68.95
|
| Rate for Payer: Humana KY Medicaid |
$69.17
|
| Rate for Payer: Kentucky WC Medicaid |
$69.88
|
| Rate for Payer: Kentucky WC Medicaid |
$69.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.38
|
| Rate for Payer: Ohio Health Group HMO |
$150.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.79
|
| Rate for Payer: PHCS Commercial |
$193.09
|
| Rate for Payer: PHCS Commercial |
$192.48
|
| Rate for Payer: United Healthcare All Payer |
$177.00
|
| Rate for Payer: United Healthcare All Payer |
$176.44
|
|
|
EPOPROSTENOL 0.5MG (1.5mg SDV)
|
Facility
|
IP
|
$200.50
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
25002050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.15 |
| Max. Negotiated Rate |
$192.48 |
| Rate for Payer: Aetna Commercial |
$154.38
|
| Rate for Payer: Aetna Commercial |
$154.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.89
|
| Rate for Payer: Cash Price |
$100.25
|
| Rate for Payer: Cash Price |
$100.57
|
| Rate for Payer: Cigna Commercial |
$166.41
|
| Rate for Payer: Cigna Commercial |
$166.95
|
| Rate for Payer: First Health Commercial |
$191.08
|
| Rate for Payer: First Health Commercial |
$190.47
|
| Rate for Payer: Humana Commercial |
$170.97
|
| Rate for Payer: Humana Commercial |
$170.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.38
|
| Rate for Payer: Ohio Health Group HMO |
$150.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.34
|
| Rate for Payer: PHCS Commercial |
$192.48
|
| Rate for Payer: PHCS Commercial |
$193.09
|
| Rate for Payer: United Healthcare All Payer |
$176.44
|
| Rate for Payer: United Healthcare All Payer |
$177.00
|
|
|
EPOPROSTENOL IV 0.5MG SDV
|
Facility
|
OP
|
$125.69
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
25002051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$120.66 |
| Rate for Payer: Aetna Commercial |
$96.78
|
| Rate for Payer: Aetna Commercial |
$99.52
|
| Rate for Payer: Anthem Medicaid |
$43.22
|
| Rate for Payer: Anthem Medicaid |
$44.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.81
|
| Rate for Payer: Cash Price |
$62.84
|
| Rate for Payer: Cash Price |
$64.62
|
| Rate for Payer: Cigna Commercial |
$107.28
|
| Rate for Payer: Cigna Commercial |
$104.32
|
| Rate for Payer: First Health Commercial |
$122.79
|
| Rate for Payer: First Health Commercial |
$119.41
|
| Rate for Payer: Humana Commercial |
$106.84
|
| Rate for Payer: Humana Commercial |
$109.86
|
| Rate for Payer: Humana KY Medicaid |
$43.22
|
| Rate for Payer: Humana KY Medicaid |
$44.45
|
| Rate for Payer: Kentucky WC Medicaid |
$44.90
|
| Rate for Payer: Kentucky WC Medicaid |
$43.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.74
|
| Rate for Payer: Ohio Health Group HMO |
$94.27
|
| Rate for Payer: Ohio Health Group HMO |
$96.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.18
|
| Rate for Payer: PHCS Commercial |
$124.08
|
| Rate for Payer: PHCS Commercial |
$120.66
|
| Rate for Payer: United Healthcare All Payer |
$113.74
|
| Rate for Payer: United Healthcare All Payer |
$110.61
|
|
|
EPOPROSTENOL IV 0.5MG SDV
|
Facility
|
IP
|
$125.69
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
25002051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$120.66 |
| Rate for Payer: Aetna Commercial |
$96.78
|
| Rate for Payer: Aetna Commercial |
$99.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.81
|
| Rate for Payer: Cash Price |
$62.84
|
| Rate for Payer: Cash Price |
$64.62
|
| Rate for Payer: Cigna Commercial |
$104.32
|
| Rate for Payer: Cigna Commercial |
$107.28
|
| Rate for Payer: First Health Commercial |
$122.79
|
| Rate for Payer: First Health Commercial |
$119.41
|
| Rate for Payer: Humana Commercial |
$109.86
|
| Rate for Payer: Humana Commercial |
$106.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.74
|
| Rate for Payer: Ohio Health Group HMO |
$94.27
|
| Rate for Payer: Ohio Health Group HMO |
$96.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.73
|
| Rate for Payer: PHCS Commercial |
$120.66
|
| Rate for Payer: PHCS Commercial |
$124.08
|
| Rate for Payer: United Healthcare All Payer |
$110.61
|
| Rate for Payer: United Healthcare All Payer |
$113.74
|
|
|
EPSOM SALT CRYSTALS 454 GM
|
Facility
|
IP
|
$5.02
|
|
|
Service Code
|
NDC 869060243
|
| Hospital Charge Code |
25000626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.77
|
| Rate for Payer: Humana Commercial |
$4.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.42
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.46
|
| Rate for Payer: PHCS Commercial |
$4.82
|
| Rate for Payer: United Healthcare All Payer |
$4.42
|
|
|
EPSOM SALT CRYSTALS 454 GM
|
Facility
|
OP
|
$5.02
|
|
|
Service Code
|
NDC 869060243
|
| Hospital Charge Code |
25000626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.77
|
| Rate for Payer: Humana Commercial |
$4.27
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.42
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.46
|
| Rate for Payer: PHCS Commercial |
$4.82
|
| Rate for Payer: United Healthcare All Payer |
$4.42
|
|
|
EQUINOXE GLENOID KEEL ALPHA L
|
Facility
|
OP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem Medicaid |
$2,873.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Humana KY Medicaid |
$2,873.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,930.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
