|
ERY-TAB (ERYTHROMYC 250MG/1TAB
|
Facility
|
OP
|
$12.99
|
|
|
Service Code
|
NDC 52536018003
|
| Hospital Charge Code |
25000631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Anthem Medicaid |
$4.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.13
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.78
|
| Rate for Payer: First Health Commercial |
$12.34
|
| Rate for Payer: Humana Commercial |
$11.04
|
| Rate for Payer: Humana KY Medicaid |
$4.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.43
|
| Rate for Payer: Ohio Health Group HMO |
$9.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.96
|
| Rate for Payer: PHCS Commercial |
$12.47
|
| Rate for Payer: United Healthcare All Payer |
$11.43
|
|
|
ERY-TAB (ERYTHROMYC 250MG/1TAB
|
Facility
|
IP
|
$12.99
|
|
|
Service Code
|
NDC 52536018003
|
| Hospital Charge Code |
25000631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.13
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.78
|
| Rate for Payer: First Health Commercial |
$12.34
|
| Rate for Payer: Humana Commercial |
$11.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.43
|
| Rate for Payer: Ohio Health Group HMO |
$9.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.96
|
| Rate for Payer: PHCS Commercial |
$12.47
|
| Rate for Payer: United Healthcare All Payer |
$11.43
|
|
|
ERYTHROMYCIN 2% GEL (60GM)
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
NDC 45802096696
|
| Hospital Charge Code |
25003049
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.99
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.86
|
| Rate for Payer: Humana Commercial |
$4.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.51
|
| Rate for Payer: Ohio Health Group HMO |
$3.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.53
|
| Rate for Payer: PHCS Commercial |
$4.92
|
| Rate for Payer: United Healthcare All Payer |
$4.51
|
|
|
ERYTHROMYCIN 2% GEL (60GM)
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
NDC 45802096696
|
| Hospital Charge Code |
25003049
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Anthem Medicaid |
$1.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.99
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.25
|
| Rate for Payer: First Health Commercial |
$4.86
|
| Rate for Payer: Humana Commercial |
$4.35
|
| Rate for Payer: Humana KY Medicaid |
$1.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.51
|
| Rate for Payer: Ohio Health Group HMO |
$3.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.53
|
| Rate for Payer: PHCS Commercial |
$4.92
|
| Rate for Payer: United Healthcare All Payer |
$4.51
|
|
|
ERYTHROMYCIN 333 TA 333MG/1TAB
|
Facility
|
OP
|
$23.28
|
|
|
Service Code
|
NDC 52536018303
|
| Hospital Charge Code |
25000632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$22.35 |
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Anthem Medicaid |
$8.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.16
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: First Health Commercial |
$22.12
|
| Rate for Payer: Humana Commercial |
$19.79
|
| Rate for Payer: Humana KY Medicaid |
$8.01
|
| Rate for Payer: Kentucky WC Medicaid |
$8.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.49
|
| Rate for Payer: Ohio Health Group HMO |
$17.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.06
|
| Rate for Payer: PHCS Commercial |
$22.35
|
| Rate for Payer: United Healthcare All Payer |
$20.49
|
|
|
ERYTHROMYCIN 333 TA 333MG/1TAB
|
Facility
|
IP
|
$23.28
|
|
|
Service Code
|
NDC 52536018303
|
| Hospital Charge Code |
25000632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$22.35 |
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.16
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: First Health Commercial |
$22.12
|
| Rate for Payer: Humana Commercial |
$19.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.49
|
| Rate for Payer: Ohio Health Group HMO |
$17.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.06
|
| Rate for Payer: PHCS Commercial |
$22.35
|
| Rate for Payer: United Healthcare All Payer |
$20.49
|
|
|
ERYTHROMYCIN LACTOBIO 500MG VL
|
Facility
|
OP
|
$537.74
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
25002054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.32 |
| Max. Negotiated Rate |
$516.23 |
| Rate for Payer: Aetna Commercial |
$414.06
|
| Rate for Payer: Anthem Medicaid |
$184.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$419.44
|
| Rate for Payer: Cash Price |
$268.87
|
| Rate for Payer: Cigna Commercial |
$446.32
|
| Rate for Payer: First Health Commercial |
$510.85
|
| Rate for Payer: Humana Commercial |
$457.08
|
| Rate for Payer: Humana KY Medicaid |
$184.93
|
| Rate for Payer: Kentucky WC Medicaid |
$186.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$473.21
|
| Rate for Payer: Ohio Health Group HMO |
$403.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$467.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.04
|
| Rate for Payer: PHCS Commercial |
$516.23
|
| Rate for Payer: United Healthcare All Payer |
$473.21
|
|
|
ERYTHROMYCIN LACTOBIO 500MG VL
|
Facility
|
IP
|
$537.74
|
|
|
Service Code
|
HCPCS J1364
|
| Hospital Charge Code |
25002054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.32 |
| Max. Negotiated Rate |
$516.23 |
| Rate for Payer: Aetna Commercial |
$414.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$419.44
|
| Rate for Payer: Cash Price |
$268.87
|
| Rate for Payer: Cigna Commercial |
$446.32
|
| Rate for Payer: First Health Commercial |
$510.85
|
| Rate for Payer: Humana Commercial |
$457.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$473.21
|
| Rate for Payer: Ohio Health Group HMO |
$403.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$467.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.04
|
| Rate for Payer: PHCS Commercial |
$516.23
|
| Rate for Payer: United Healthcare All Payer |
$473.21
|
|
|
ERYTHROMYCIN OPHTH 1 GM
|
Facility
|
IP
|
$24.25
|
|
|
Service Code
|
NDC 574402450
|
| Hospital Charge Code |
25000633
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.91
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cigna Commercial |
$20.13
|
| Rate for Payer: First Health Commercial |
$23.04
|
| Rate for Payer: Humana Commercial |
$20.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.34
|
| Rate for Payer: Ohio Health Group HMO |
$18.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.73
|
| Rate for Payer: PHCS Commercial |
$23.28
|
| Rate for Payer: United Healthcare All Payer |
$21.34
|
|
|
ERYTHROMYCIN OPHTH 1 GM
|
Facility
|
OP
|
$24.25
|
|
|
Service Code
|
NDC 574402450
|
| Hospital Charge Code |
25000633
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Anthem Medicaid |
$8.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.91
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cigna Commercial |
$20.13
|
| Rate for Payer: First Health Commercial |
$23.04
|
| Rate for Payer: Humana Commercial |
$20.61
|
| Rate for Payer: Humana KY Medicaid |
$8.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.34
|
| Rate for Payer: Ohio Health Group HMO |
$18.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.73
|
| Rate for Payer: PHCS Commercial |
$23.28
|
| Rate for Payer: United Healthcare All Payer |
$21.34
|
|
|
ERYTHROMYCIN OPHTH OINT 3.5GM
|
Facility
|
OP
|
$3.01
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
25000634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Anthem Medicaid |
$1.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.35
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$2.50
|
| Rate for Payer: First Health Commercial |
$2.86
|
| Rate for Payer: Humana Commercial |
$2.56
|
| Rate for Payer: Humana KY Medicaid |
$1.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.65
|
| Rate for Payer: Ohio Health Group HMO |
$2.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.08
|
| Rate for Payer: PHCS Commercial |
$2.89
|
| Rate for Payer: United Healthcare All Payer |
$2.65
|
|
|
ERYTHROMYCIN OPHTH OINT 3.5GM
|
Facility
|
IP
|
$3.01
|
|
|
Service Code
|
NDC 24208091055
|
| Hospital Charge Code |
25000634
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.35
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$2.50
|
| Rate for Payer: First Health Commercial |
$2.86
|
| Rate for Payer: Humana Commercial |
$2.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.65
|
| Rate for Payer: Ohio Health Group HMO |
$2.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.08
|
| Rate for Payer: PHCS Commercial |
$2.89
|
| Rate for Payer: United Healthcare All Payer |
$2.65
|
|
|
ESCHERCHIA COLL OPPA GENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001291
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
ESCHERCHIA COLL OPPA GENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001291
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
ESKALITH CR (LITHIU 450MG/1TAB
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 378145001
|
| Hospital Charge Code |
25000635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
|
|
ESKALITH CR (LITHIU 450MG/1TAB
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 378145001
|
| Hospital Charge Code |
25000635
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.17
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
|
|
ESMOLOL 10mg (100mg SDV)
|
Facility
|
IP
|
$80.40
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
25002904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$77.18 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.71
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$66.73
|
| Rate for Payer: First Health Commercial |
$76.38
|
| Rate for Payer: Humana Commercial |
$68.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.75
|
| Rate for Payer: Ohio Health Group HMO |
$60.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.48
|
| Rate for Payer: PHCS Commercial |
$77.18
|
| Rate for Payer: United Healthcare All Payer |
$70.75
|
|
|
ESMOLOL 10mg (100mg SDV)
|
Facility
|
OP
|
$80.40
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
25002904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$77.18 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Anthem Medicaid |
$27.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.71
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$66.73
|
| Rate for Payer: First Health Commercial |
$76.38
|
| Rate for Payer: Humana Commercial |
$68.34
|
| Rate for Payer: Humana KY Medicaid |
$27.65
|
| Rate for Payer: Kentucky WC Medicaid |
$27.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.75
|
| Rate for Payer: Ohio Health Group HMO |
$60.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.48
|
| Rate for Payer: PHCS Commercial |
$77.18
|
| Rate for Payer: United Healthcare All Payer |
$70.75
|
|
|
ESMOLOL(GENERIC)10MG(250ML)
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
25002903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.90 |
| Max. Negotiated Rate |
$569.28 |
| Rate for Payer: Aetna Commercial |
$456.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$462.54
|
| Rate for Payer: Cash Price |
$296.50
|
| Rate for Payer: Cigna Commercial |
$492.19
|
| Rate for Payer: First Health Commercial |
$563.35
|
| Rate for Payer: Humana Commercial |
$504.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$486.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$437.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$521.84
|
| Rate for Payer: Ohio Health Group HMO |
$444.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.17
|
| Rate for Payer: PHCS Commercial |
$569.28
|
| Rate for Payer: United Healthcare All Payer |
$521.84
|
|
|
ESMOLOL(GENERIC)10MG(250ML)
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
25002903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.90 |
| Max. Negotiated Rate |
$569.28 |
| Rate for Payer: Aetna Commercial |
$456.61
|
| Rate for Payer: Anthem Medicaid |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$462.54
|
| Rate for Payer: Cash Price |
$296.50
|
| Rate for Payer: Cigna Commercial |
$492.19
|
| Rate for Payer: First Health Commercial |
$563.35
|
| Rate for Payer: Humana Commercial |
$504.05
|
| Rate for Payer: Humana KY Medicaid |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$206.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$486.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$437.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$521.84
|
| Rate for Payer: Ohio Health Group HMO |
$444.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.17
|
| Rate for Payer: PHCS Commercial |
$569.28
|
| Rate for Payer: United Healthcare All Payer |
$521.84
|
|
|
ESOPHAGEAL CAPSULE ENDOSCOP(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 91111
|
| Hospital Charge Code |
750P0007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$1,020.39 |
| Rate for Payer: Aetna Commercial |
$1,020.39
|
| Rate for Payer: Ambetter Exchange |
$735.06
|
| Rate for Payer: Anthem Medicaid |
$584.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$735.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$735.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$882.07
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$942.95
|
| Rate for Payer: Healthspan PPO |
$835.02
|
| Rate for Payer: Humana Medicaid |
$584.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$735.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$735.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$595.93
|
| Rate for Payer: Molina Healthcare Passport |
$584.25
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$955.58
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$590.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$735.06
|
|
|
ESOPHAGEAL CAPSULE ENDOSCOP(T
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
HCPCS 91111
|
| Hospital Charge Code |
750T0007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$359.40 |
| Max. Negotiated Rate |
$1,150.08 |
| Rate for Payer: Aetna Commercial |
$922.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$934.44
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Cigna Commercial |
$994.34
|
| Rate for Payer: First Health Commercial |
$1,138.10
|
| Rate for Payer: Humana Commercial |
$1,018.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$982.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$884.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,054.24
|
| Rate for Payer: Ohio Health Group HMO |
$898.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.62
|
| Rate for Payer: PHCS Commercial |
$1,150.08
|
| Rate for Payer: United Healthcare All Payer |
$1,054.24
|
|
|
ESOPHAGEAL CAPSULE ENDOSCOP(T
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
HCPCS 91111
|
| Hospital Charge Code |
750T0007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$411.99 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$922.46
|
| Rate for Payer: Anthem Medicaid |
$411.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$934.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Cigna Commercial |
$994.34
|
| Rate for Payer: First Health Commercial |
$1,138.10
|
| Rate for Payer: Humana Commercial |
$1,018.30
|
| Rate for Payer: Humana KY Medicaid |
$411.99
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$416.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$982.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$884.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,054.24
|
| Rate for Payer: Ohio Health Group HMO |
$898.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.62
|
| Rate for Payer: PHCS Commercial |
$1,150.08
|
| Rate for Payer: United Healthcare All Payer |
$1,054.24
|
|
|
ESOPHAGEAL CAPSULE ENDOSCOPY
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
HCPCS 91111
|
| Hospital Charge Code |
75000007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$434.40 |
| Max. Negotiated Rate |
$1,390.08 |
| Rate for Payer: Aetna Commercial |
$1,114.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,129.44
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cigna Commercial |
$1,201.84
|
| Rate for Payer: First Health Commercial |
$1,375.60
|
| Rate for Payer: Humana Commercial |
$1,230.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,187.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,068.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$434.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,274.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$999.12
|
| Rate for Payer: PHCS Commercial |
$1,390.08
|
| Rate for Payer: United Healthcare All Payer |
$1,274.24
|
|
|
ESOPHAGEAL CAPSULE ENDOSCOPY
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
HCPCS 91111
|
| Hospital Charge Code |
75000007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$497.97 |
| Max. Negotiated Rate |
$1,390.08 |
| Rate for Payer: Aetna Commercial |
$1,114.96
|
| Rate for Payer: Anthem Medicaid |
$497.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,129.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cigna Commercial |
$1,201.84
|
| Rate for Payer: First Health Commercial |
$1,375.60
|
| Rate for Payer: Humana Commercial |
$1,230.80
|
| Rate for Payer: Humana KY Medicaid |
$497.97
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$503.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,187.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,068.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$507.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,274.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$999.12
|
| Rate for Payer: PHCS Commercial |
$1,390.08
|
| Rate for Payer: United Healthcare All Payer |
$1,274.24
|
|
