|
ESTRADIOL 50MG PELLET
|
Professional
|
Both
|
$144.48
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.57 |
| Max. Negotiated Rate |
$101.14 |
| Rate for Payer: Cash Price |
$72.24
|
| Rate for Payer: Multiplan PHCS |
$86.69
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.14
|
| Rate for Payer: UHCCP Medicaid |
$50.57
|
|
|
ESTRADIOL 50MG PELLET
|
Facility
|
IP
|
$144.48
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
636T0228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna Commercial |
$111.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.69
|
| Rate for Payer: Cash Price |
$72.24
|
| Rate for Payer: Cigna Commercial |
$119.92
|
| Rate for Payer: First Health Commercial |
$137.26
|
| Rate for Payer: Humana Commercial |
$122.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.14
|
| Rate for Payer: Ohio Health Group HMO |
$108.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.69
|
| Rate for Payer: PHCS Commercial |
$138.70
|
| Rate for Payer: United Healthcare All Payer |
$127.14
|
|
|
ESTRADIOL;TOTAL
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
30000312
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna Commercial |
$187.11
|
| Rate for Payer: Anthem Medicaid |
$27.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.94
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$201.69
|
| Rate for Payer: First Health Commercial |
$230.85
|
| Rate for Payer: Humana Commercial |
$206.55
|
| Rate for Payer: Humana KY Medicaid |
$27.94
|
| Rate for Payer: Humana Medicare Advantage |
$27.94
|
| Rate for Payer: Kentucky WC Medicaid |
$28.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.84
|
| Rate for Payer: Ohio Health Group HMO |
$182.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$211.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.67
|
| Rate for Payer: PHCS Commercial |
$233.28
|
| Rate for Payer: United Healthcare All Payer |
$213.84
|
|
|
ESTRADIOL;TOTAL
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
30000312
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna Commercial |
$26.49
|
| Rate for Payer: Ambetter Exchange |
$27.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$27.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$27.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.53
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$24.70
|
| Rate for Payer: Healthspan PPO |
$29.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$27.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.94
|
| Rate for Payer: Multiplan PHCS |
$145.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.32
|
| Rate for Payer: UHCCP Medicaid |
$85.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.94
|
|
|
ESTRADIOL;TOTAL
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
30000312
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.90 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna Commercial |
$187.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.13
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$201.69
|
| Rate for Payer: First Health Commercial |
$230.85
|
| Rate for Payer: Humana Commercial |
$206.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.84
|
| Rate for Payer: Ohio Health Group HMO |
$182.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$211.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.67
|
| Rate for Payer: PHCS Commercial |
$233.28
|
| Rate for Payer: United Healthcare All Payer |
$213.84
|
|
|
ETHMOIDECTOMY; INTRANASAL, ANT
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 31200
|
| Hospital Charge Code |
76101146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.91 |
| Max. Negotiated Rate |
$786.90 |
| Rate for Payer: Aetna Commercial |
$735.99
|
| Rate for Payer: Ambetter Exchange |
$568.29
|
| Rate for Payer: Anthem Medicaid |
$272.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$568.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$568.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$681.95
|
| Rate for Payer: Cash Price |
$559.50
|
| Rate for Payer: Cash Price |
$559.50
|
| Rate for Payer: Cigna Commercial |
$786.90
|
| Rate for Payer: Healthspan PPO |
$620.68
|
| Rate for Payer: Humana Medicaid |
$272.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$684.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$568.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.37
|
| Rate for Payer: Molina Healthcare Passport |
$272.91
|
| Rate for Payer: Multiplan PHCS |
$671.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$738.78
|
| Rate for Payer: UHCCP Medicaid |
$391.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$568.29
|
|
|
ETHMOIDECTOMY; INTRANASAL, ANT
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 31200
|
| Hospital Charge Code |
761P1146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.91 |
| Max. Negotiated Rate |
$786.90 |
| Rate for Payer: Aetna Commercial |
$735.99
|
| Rate for Payer: Ambetter Exchange |
$568.29
|
| Rate for Payer: Anthem Medicaid |
$272.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$568.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$568.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$681.95
|
| Rate for Payer: Cash Price |
$559.50
|
| Rate for Payer: Cash Price |
$559.50
|
| Rate for Payer: Cigna Commercial |
$786.90
|
| Rate for Payer: Healthspan PPO |
$620.68
|
| Rate for Payer: Humana Medicaid |
$272.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$684.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$568.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.37
|
| Rate for Payer: Molina Healthcare Passport |
$272.91
|
| Rate for Payer: Multiplan PHCS |
$671.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$738.78
|
| Rate for Payer: UHCCP Medicaid |
$391.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$275.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$568.29
|
|
|
ETHMOIDECTOMY; INTRANASAL, ANT
|
Facility
|
IP
|
$1,119.00
|
|
|
Service Code
|
HCPCS 31200
|
| Hospital Charge Code |
76101146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.70 |
| Max. Negotiated Rate |
$1,074.24 |
| Rate for Payer: Aetna Commercial |
$861.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$872.82
|
| Rate for Payer: Cash Price |
$559.50
|
| Rate for Payer: Cigna Commercial |
$928.77
|
| Rate for Payer: First Health Commercial |
$1,063.05
|
| Rate for Payer: Humana Commercial |
$951.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$917.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$825.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$335.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$984.72
|
| Rate for Payer: Ohio Health Group HMO |
$839.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$973.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.11
|
| Rate for Payer: PHCS Commercial |
$1,074.24
|
| Rate for Payer: United Healthcare All Payer |
$984.72
|
|
|
ETHMOIDECTOMY; INTRANASAL, ANT
|
Facility
|
OP
|
$1,119.00
|
|
|
Service Code
|
HCPCS 31200
|
| Hospital Charge Code |
76101146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.82 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$861.63
|
| Rate for Payer: Anthem Medicaid |
$384.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$872.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$559.50
|
| Rate for Payer: Cash Price |
$559.50
|
| Rate for Payer: Cigna Commercial |
$928.77
|
| Rate for Payer: First Health Commercial |
$1,063.05
|
| Rate for Payer: Humana Commercial |
$951.15
|
| Rate for Payer: Humana KY Medicaid |
$384.82
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$388.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$917.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$825.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$392.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$984.72
|
| Rate for Payer: Ohio Health Group HMO |
$839.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$973.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.11
|
| Rate for Payer: PHCS Commercial |
$1,074.24
|
| Rate for Payer: United Healthcare All Payer |
$984.72
|
|
|
ETHYL CHLORIDE100SPRAY/103.5ML
|
Facility
|
IP
|
$1.90
|
|
|
Service Code
|
NDC 386000104
|
| Hospital Charge Code |
25003819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna Commercial |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.48
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna Commercial |
$1.58
|
| Rate for Payer: First Health Commercial |
$1.80
|
| Rate for Payer: Humana Commercial |
$1.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.67
|
| Rate for Payer: Ohio Health Group HMO |
$1.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Payer |
$1.67
|
|
|
ETHYL CHLORIDE100SPRAY/103.5ML
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
NDC 386000104
|
| Hospital Charge Code |
25003819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna Commercial |
$1.46
|
| Rate for Payer: Anthem Medicaid |
$0.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.48
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna Commercial |
$1.58
|
| Rate for Payer: First Health Commercial |
$1.80
|
| Rate for Payer: Humana Commercial |
$1.61
|
| Rate for Payer: Humana KY Medicaid |
$0.65
|
| Rate for Payer: Kentucky WC Medicaid |
$0.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.67
|
| Rate for Payer: Ohio Health Group HMO |
$1.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$1.82
|
| Rate for Payer: United Healthcare All Payer |
$1.67
|
|
|
ETHYOL(AMIFOSTINE) 500MG/10ML
|
Facility
|
OP
|
$5,839.18
|
|
|
Service Code
|
HCPCS J0207
|
| Hospital Charge Code |
25001840
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,751.75 |
| Max. Negotiated Rate |
$5,605.61 |
| Rate for Payer: Aetna Commercial |
$4,496.17
|
| Rate for Payer: Anthem Medicaid |
$2,008.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,554.56
|
| Rate for Payer: Cash Price |
$2,919.59
|
| Rate for Payer: Cigna Commercial |
$4,846.52
|
| Rate for Payer: First Health Commercial |
$5,547.22
|
| Rate for Payer: Humana Commercial |
$4,963.30
|
| Rate for Payer: Humana KY Medicaid |
$2,008.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,028.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,788.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,309.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,751.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,048.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,138.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,379.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,671.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,080.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,029.03
|
| Rate for Payer: PHCS Commercial |
$5,605.61
|
| Rate for Payer: United Healthcare All Payer |
$5,138.48
|
|
|
ETHYOL(AMIFOSTINE) 500MG/10ML
|
Facility
|
IP
|
$5,839.18
|
|
|
Service Code
|
HCPCS J0207
|
| Hospital Charge Code |
25001840
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,751.75 |
| Max. Negotiated Rate |
$5,605.61 |
| Rate for Payer: Aetna Commercial |
$4,496.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,554.56
|
| Rate for Payer: Cash Price |
$2,919.59
|
| Rate for Payer: Cigna Commercial |
$4,846.52
|
| Rate for Payer: First Health Commercial |
$5,547.22
|
| Rate for Payer: Humana Commercial |
$4,963.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,788.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,309.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,751.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,138.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,379.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,671.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,080.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,029.03
|
| Rate for Payer: PHCS Commercial |
$5,605.61
|
| Rate for Payer: United Healthcare All Payer |
$5,138.48
|
|
|
ETHYOL SQ 500MG VIAL
|
Facility
|
OP
|
$5,839.18
|
|
|
Service Code
|
HCPCS J0207
|
| Hospital Charge Code |
25001841
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,751.75 |
| Max. Negotiated Rate |
$5,605.61 |
| Rate for Payer: Aetna Commercial |
$4,496.17
|
| Rate for Payer: Anthem Medicaid |
$2,008.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,554.56
|
| Rate for Payer: Cash Price |
$2,919.59
|
| Rate for Payer: Cigna Commercial |
$4,846.52
|
| Rate for Payer: First Health Commercial |
$5,547.22
|
| Rate for Payer: Humana Commercial |
$4,963.30
|
| Rate for Payer: Humana KY Medicaid |
$2,008.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,028.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,788.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,309.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,751.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,048.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,138.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,379.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,671.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,080.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,029.03
|
| Rate for Payer: PHCS Commercial |
$5,605.61
|
| Rate for Payer: United Healthcare All Payer |
$5,138.48
|
|
|
ETHYOL SQ 500MG VIAL
|
Facility
|
IP
|
$5,839.18
|
|
|
Service Code
|
HCPCS J0207
|
| Hospital Charge Code |
25001841
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,751.75 |
| Max. Negotiated Rate |
$5,605.61 |
| Rate for Payer: Aetna Commercial |
$4,496.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,554.56
|
| Rate for Payer: Cash Price |
$2,919.59
|
| Rate for Payer: Cigna Commercial |
$4,846.52
|
| Rate for Payer: First Health Commercial |
$5,547.22
|
| Rate for Payer: Humana Commercial |
$4,963.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,788.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,309.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,751.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,138.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,379.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,671.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,080.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,029.03
|
| Rate for Payer: PHCS Commercial |
$5,605.61
|
| Rate for Payer: United Healthcare All Payer |
$5,138.48
|
|
|
ETOPOSIDE 10MG (1000MG MDV)
|
Facility
|
OP
|
$6.76
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
25004037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$6.49 |
| Rate for Payer: Aetna Commercial |
$5.21
|
| Rate for Payer: Anthem Medicaid |
$2.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.27
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cigna Commercial |
$5.61
|
| Rate for Payer: First Health Commercial |
$6.42
|
| Rate for Payer: Humana Commercial |
$5.75
|
| Rate for Payer: Humana KY Medicaid |
$2.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.95
|
| Rate for Payer: Ohio Health Group HMO |
$5.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.66
|
| Rate for Payer: PHCS Commercial |
$6.49
|
| Rate for Payer: United Healthcare All Payer |
$5.95
|
|
|
ETOPOSIDE 10MG (1000MG MDV)
|
Facility
|
IP
|
$6.76
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
25004037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$6.49 |
| Rate for Payer: Aetna Commercial |
$5.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.27
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cigna Commercial |
$5.61
|
| Rate for Payer: First Health Commercial |
$6.42
|
| Rate for Payer: Humana Commercial |
$5.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.95
|
| Rate for Payer: Ohio Health Group HMO |
$5.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.66
|
| Rate for Payer: PHCS Commercial |
$6.49
|
| Rate for Payer: United Healthcare All Payer |
$5.95
|
|
|
ETOPOSIDE 10MG (100MG MDV)
|
Facility
|
IP
|
$5.61
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
25004035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna Commercial |
$4.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.38
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cigna Commercial |
$4.66
|
| Rate for Payer: First Health Commercial |
$5.33
|
| Rate for Payer: Humana Commercial |
$4.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.94
|
| Rate for Payer: Ohio Health Group HMO |
$4.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.87
|
| Rate for Payer: PHCS Commercial |
$5.39
|
| Rate for Payer: United Healthcare All Payer |
$4.94
|
|
|
ETOPOSIDE 10MG (100MG MDV)
|
Facility
|
OP
|
$5.61
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
25004035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna Commercial |
$4.32
|
| Rate for Payer: Anthem Medicaid |
$1.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.38
|
| Rate for Payer: Cash Price |
$2.81
|
| Rate for Payer: Cigna Commercial |
$4.66
|
| Rate for Payer: First Health Commercial |
$5.33
|
| Rate for Payer: Humana Commercial |
$4.77
|
| Rate for Payer: Humana KY Medicaid |
$1.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.94
|
| Rate for Payer: Ohio Health Group HMO |
$4.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.87
|
| Rate for Payer: PHCS Commercial |
$5.39
|
| Rate for Payer: United Healthcare All Payer |
$4.94
|
|
|
ETOPOSIDE 10MG (500MG MDV)
|
Facility
|
OP
|
$6.76
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
25004036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$6.49 |
| Rate for Payer: Aetna Commercial |
$5.21
|
| Rate for Payer: Anthem Medicaid |
$2.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.27
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cigna Commercial |
$5.61
|
| Rate for Payer: First Health Commercial |
$6.42
|
| Rate for Payer: Humana Commercial |
$5.75
|
| Rate for Payer: Humana KY Medicaid |
$2.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.95
|
| Rate for Payer: Ohio Health Group HMO |
$5.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.66
|
| Rate for Payer: PHCS Commercial |
$6.49
|
| Rate for Payer: United Healthcare All Payer |
$5.95
|
|
|
ETOPOSIDE 10MG (500MG MDV)
|
Facility
|
IP
|
$6.76
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
25004036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$6.49 |
| Rate for Payer: Aetna Commercial |
$5.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5.27
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cigna Commercial |
$5.61
|
| Rate for Payer: First Health Commercial |
$6.42
|
| Rate for Payer: Humana Commercial |
$5.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5.95
|
| Rate for Payer: Ohio Health Group HMO |
$5.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.66
|
| Rate for Payer: PHCS Commercial |
$6.49
|
| Rate for Payer: United Healthcare All Payer |
$5.95
|
|
|
EUCERIN 57G CRM
|
Facility
|
OP
|
$5.11
|
|
|
Service Code
|
NDC 72140003868
|
| Hospital Charge Code |
25004551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna Commercial |
$3.93
|
| 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 |
$4.24
|
| Rate for Payer: First Health Commercial |
$4.85
|
| Rate for Payer: Humana Commercial |
$4.34
|
| Rate for Payer: Humana KY Medicaid |
$1.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.50
|
| Rate for Payer: Ohio Health Group HMO |
$3.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.09
|
| 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 |
$4.91
|
| Rate for Payer: United Healthcare All Payer |
$4.50
|
|
|
EUCERIN 57G CRM
|
Facility
|
IP
|
$5.11
|
|
|
Service Code
|
NDC 72140003868
|
| Hospital Charge Code |
25004551
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.99
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Cigna Commercial |
$4.24
|
| Rate for Payer: First Health Commercial |
$4.85
|
| Rate for Payer: Humana Commercial |
$4.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.50
|
| Rate for Payer: Ohio Health Group HMO |
$3.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.09
|
| 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 |
$4.91
|
| Rate for Payer: United Healthcare All Payer |
$4.50
|
|
|
EUCERIN CREAM 120 GM
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 72140000022
|
| Hospital Charge Code |
25000639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Anthem Medicaid |
$0.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna Commercial |
$0.22
|
| Rate for Payer: First Health Commercial |
$0.25
|
| Rate for Payer: Humana Commercial |
$0.22
|
| Rate for Payer: Humana KY Medicaid |
$0.09
|
| Rate for Payer: Kentucky WC Medicaid |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.23
|
| Rate for Payer: Ohio Health Group HMO |
$0.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.18
|
| Rate for Payer: PHCS Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Payer |
$0.23
|
|
|
EUCERIN CREAM 120 GM
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
NDC 72140000022
|
| Hospital Charge Code |
25000639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Cash Price |
$0.13
|
| Rate for Payer: Cigna Commercial |
$0.22
|
| Rate for Payer: First Health Commercial |
$0.25
|
| Rate for Payer: Humana Commercial |
$0.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.23
|
| Rate for Payer: Ohio Health Group HMO |
$0.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.18
|
| Rate for Payer: PHCS Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Payer |
$0.23
|
|
