|
HYDRATION INIT INFUS 1HR
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$47.32 |
| Max. Negotiated Rate |
$349.44 |
| Rate for Payer: Aetna Commercial |
$280.28
|
| Rate for Payer: Anthem Medicaid |
$125.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$283.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$259.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.22
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$302.12
|
| Rate for Payer: First Health Commercial |
$345.80
|
| Rate for Payer: Humana Commercial |
$309.40
|
| Rate for Payer: Humana KY Medicaid |
$125.18
|
| Rate for Payer: Humana Medicare Advantage |
$185.35
|
| Rate for Payer: Kentucky WC Medicaid |
$126.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$298.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$268.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$127.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$320.32
|
| Rate for Payer: Ohio Health Group HMO |
$273.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.84
|
| Rate for Payer: PHCS Commercial |
$349.44
|
| Rate for Payer: United Healthcare All Payer |
$320.32
|
|
|
HYDREA (HYDROXYUREA 500MG/1CAP
|
Facility
|
OP
|
$5.01
|
|
|
Service Code
|
NDC 68084028401
|
| Hospital Charge Code |
25000755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Anthem Medicaid |
$1.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.91
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: First Health Commercial |
$4.76
|
| Rate for Payer: Humana Commercial |
$4.26
|
| Rate for Payer: Humana KY Medicaid |
$1.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.41
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
|
|
HYDREA (HYDROXYUREA 500MG/1CAP
|
Facility
|
IP
|
$5.01
|
|
|
Service Code
|
NDC 68084028401
|
| Hospital Charge Code |
25000755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.91
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: First Health Commercial |
$4.76
|
| Rate for Payer: Humana Commercial |
$4.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.41
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
|
|
HYDROCHLORIC ACID 0.1 NO 8.5ML
|
Facility
|
OP
|
$63.47
|
|
|
Service Code
|
NDC 38779058408
|
| Hospital Charge Code |
25003103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna Commercial |
$48.87
|
| Rate for Payer: Anthem Medicaid |
$21.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.51
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Cigna Commercial |
$52.68
|
| Rate for Payer: First Health Commercial |
$60.30
|
| Rate for Payer: Humana Commercial |
$53.95
|
| Rate for Payer: Humana KY Medicaid |
$21.83
|
| Rate for Payer: Kentucky WC Medicaid |
$22.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.85
|
| Rate for Payer: Ohio Health Group HMO |
$47.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.68
|
| Rate for Payer: PHCS Commercial |
$60.93
|
| Rate for Payer: United Healthcare All Payer |
$55.85
|
|
|
HYDROCHLORIC ACID 0.1 NO 8.5ML
|
Facility
|
IP
|
$63.47
|
|
|
Service Code
|
NDC 38779058408
|
| Hospital Charge Code |
25003103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna Commercial |
$48.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.51
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Cigna Commercial |
$52.68
|
| Rate for Payer: First Health Commercial |
$60.30
|
| Rate for Payer: Humana Commercial |
$53.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.85
|
| Rate for Payer: Ohio Health Group HMO |
$47.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.68
|
| Rate for Payer: PHCS Commercial |
$60.93
|
| Rate for Payer: United Healthcare All Payer |
$55.85
|
|
|
HYDROCODONE-ACETAMN 7.5-325/15
|
Facility
|
OP
|
$64.66
|
|
|
Service Code
|
NDC 121231650
|
| Hospital Charge Code |
25004139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$62.07 |
| Rate for Payer: Aetna Commercial |
$49.79
|
| Rate for Payer: Anthem Medicaid |
$22.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.43
|
| Rate for Payer: Cash Price |
$32.33
|
| Rate for Payer: Cigna Commercial |
$53.67
|
| Rate for Payer: First Health Commercial |
$61.43
|
| Rate for Payer: Humana Commercial |
$54.96
|
| Rate for Payer: Humana KY Medicaid |
$22.24
|
| Rate for Payer: Kentucky WC Medicaid |
$22.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.90
|
| Rate for Payer: Ohio Health Group HMO |
$48.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.04
|
| Rate for Payer: PHCS Commercial |
$62.07
|
| Rate for Payer: United Healthcare All Payer |
$56.90
|
|
|
HYDROCODONE-ACETAMN 7.5-325/15
|
Facility
|
IP
|
$64.66
|
|
|
Service Code
|
NDC 121231650
|
| Hospital Charge Code |
25004139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$62.07 |
| Rate for Payer: Aetna Commercial |
$49.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.43
|
| Rate for Payer: Cash Price |
$32.33
|
| Rate for Payer: Cigna Commercial |
$53.67
|
| Rate for Payer: First Health Commercial |
$61.43
|
| Rate for Payer: Humana Commercial |
$54.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.90
|
| Rate for Payer: Ohio Health Group HMO |
$48.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.04
|
| Rate for Payer: PHCS Commercial |
$62.07
|
| Rate for Payer: United Healthcare All Payer |
$56.90
|
|
|
HYDROCORTISONE 1% CREAM 3 30GM
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 45802043803
|
| Hospital Charge Code |
25000758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna Commercial |
$0.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.07
|
| Rate for Payer: First Health Commercial |
$0.08
|
| Rate for Payer: Humana Commercial |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.07
|
| Rate for Payer: Ohio Health Group HMO |
$0.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Payer |
$0.07
|
|
|
HYDROCORTISONE 1% CREAM 3 30GM
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 45802043803
|
| Hospital Charge Code |
25000758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna Commercial |
$0.06
|
| Rate for Payer: Anthem Medicaid |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.06
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.07
|
| Rate for Payer: First Health Commercial |
$0.08
|
| Rate for Payer: Humana Commercial |
$0.07
|
| Rate for Payer: Humana KY Medicaid |
$0.03
|
| Rate for Payer: Kentucky WC Medicaid |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.07
|
| Rate for Payer: Ohio Health Group HMO |
$0.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Payer |
$0.07
|
|
|
HYDROCORTISONE 1% OINT 30 GRAM
|
Facility
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 168002031
|
| Hospital Charge Code |
25000759
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna Commercial |
$2.24
|
| Rate for Payer: Anthem Medicaid |
$1.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.27
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna Commercial |
$2.42
|
| Rate for Payer: First Health Commercial |
$2.76
|
| Rate for Payer: Humana Commercial |
$2.47
|
| Rate for Payer: Humana KY Medicaid |
$1.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.56
|
| Rate for Payer: Ohio Health Group HMO |
$2.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.90
|
| Rate for Payer: PHCS Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Payer |
$2.56
|
|
|
HYDROCORTISONE 1% OINT 30 GRAM
|
Facility
|
IP
|
$2.91
|
|
|
Service Code
|
NDC 168002031
|
| Hospital Charge Code |
25000759
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna Commercial |
$2.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.27
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cigna Commercial |
$2.42
|
| Rate for Payer: First Health Commercial |
$2.76
|
| Rate for Payer: Humana Commercial |
$2.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.56
|
| Rate for Payer: Ohio Health Group HMO |
$2.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.90
|
| Rate for Payer: PHCS Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Payer |
$2.56
|
|
|
HYDROCORTISONE 2.5% CREAM 30GM
|
Facility
|
IP
|
$1.73
|
|
|
Service Code
|
NDC 51672300302
|
| Hospital Charge Code |
25000760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.35
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna Commercial |
$1.44
|
| Rate for Payer: First Health Commercial |
$1.64
|
| Rate for Payer: Humana Commercial |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.52
|
| Rate for Payer: Ohio Health Group HMO |
$1.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.54
|
| Rate for Payer: PHCS Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Payer |
$1.52
|
|
|
HYDROCORTISONE 2.5% CREAM 30GM
|
Facility
|
OP
|
$1.73
|
|
|
Service Code
|
NDC 51672300302
|
| Hospital Charge Code |
25000760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$1.66 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: Anthem Medicaid |
$0.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.35
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Cigna Commercial |
$1.44
|
| Rate for Payer: First Health Commercial |
$1.64
|
| Rate for Payer: Humana Commercial |
$1.47
|
| Rate for Payer: Humana KY Medicaid |
$0.59
|
| Rate for Payer: Kentucky WC Medicaid |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.52
|
| Rate for Payer: Ohio Health Group HMO |
$1.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.54
|
| Rate for Payer: PHCS Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Payer |
$1.52
|
|
|
HYDRODIURIL (HCTZ) 2 25MG/1TAB
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25000761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
HYDRODIURIL (HCTZ) 2 25MG/1TAB
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25000761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
HYDROGENPEROX 1.5% ORL (30ML)
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 38341008016
|
| Hospital Charge Code |
25003105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
|
HYDROGENPEROX 1.5% ORL (30ML)
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 38341008016
|
| Hospital Charge Code |
25003105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
|
HYDROGEN PEROXIDE 3% SOL 473ML
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 46122033443
|
| Hospital Charge Code |
25000762
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Anthem Medicaid |
$0.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: Humana Commercial |
$0.01
|
| Rate for Payer: Humana KY Medicaid |
$0.00
|
| Rate for Payer: Kentucky WC Medicaid |
$0.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.01
|
| Rate for Payer: Ohio Health Group HMO |
$0.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.00
|
| Rate for Payer: PHCS Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Payer |
$0.01
|
|
|
HYDROGEN PEROXIDE 3% SOL 473ML
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 46122033443
|
| Hospital Charge Code |
25000762
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: Humana Commercial |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.01
|
| Rate for Payer: Ohio Health Group HMO |
$0.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.00
|
| Rate for Payer: PHCS Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Payer |
$0.01
|
|
|
HYDROMORPHONE 100mg/100mL DRIP
|
Facility
|
IP
|
$99.92
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
25004277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$95.92 |
| Rate for Payer: Aetna Commercial |
$76.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.94
|
| Rate for Payer: Cash Price |
$49.96
|
| Rate for Payer: Cigna Commercial |
$82.93
|
| Rate for Payer: First Health Commercial |
$94.92
|
| Rate for Payer: Humana Commercial |
$84.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.93
|
| Rate for Payer: Ohio Health Group HMO |
$74.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.98
|
| Rate for Payer: PHCS Commercial |
$95.92
|
| Rate for Payer: United Healthcare All Payer |
$87.93
|
|
|
HYDROMORPHONE 100mg/100mL DRIP
|
Facility
|
OP
|
$99.92
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
25004277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$95.92 |
| Rate for Payer: Aetna Commercial |
$76.94
|
| Rate for Payer: Anthem Medicaid |
$34.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.94
|
| Rate for Payer: Cash Price |
$49.96
|
| Rate for Payer: Cigna Commercial |
$82.93
|
| Rate for Payer: First Health Commercial |
$94.92
|
| Rate for Payer: Humana Commercial |
$84.93
|
| Rate for Payer: Humana KY Medicaid |
$34.36
|
| Rate for Payer: Kentucky WC Medicaid |
$34.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.93
|
| Rate for Payer: Ohio Health Group HMO |
$74.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.98
|
| Rate for Payer: PHCS Commercial |
$95.92
|
| Rate for Payer: United Healthcare All Payer |
$87.93
|
|
|
HYDROMORPHONE10MG/ML PFAMP(5ML
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
25002032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$31.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.76
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$31.64
|
| Rate for Payer: Kentucky WC Medicaid |
$31.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
HYDROMORPHONE10MG/ML PFAMP(5ML
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
25002032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.76
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
HYDROPHOR OINTMENT 100 GM
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 61924018404
|
| Hospital Charge Code |
25000764
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna Commercial |
$0.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna Commercial |
$0.08
|
| Rate for Payer: First Health Commercial |
$0.10
|
| Rate for Payer: Humana Commercial |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.09
|
| Rate for Payer: Ohio Health Group HMO |
$0.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Payer |
$0.09
|
|
|
HYDROPHOR OINTMENT 100 GM
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 61924018404
|
| Hospital Charge Code |
25000764
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Aetna Commercial |
$0.08
|
| Rate for Payer: Anthem Medicaid |
$0.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.08
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: Cigna Commercial |
$0.08
|
| Rate for Payer: First Health Commercial |
$0.10
|
| Rate for Payer: Humana Commercial |
$0.09
|
| Rate for Payer: Humana KY Medicaid |
$0.03
|
| Rate for Payer: Kentucky WC Medicaid |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.09
|
| Rate for Payer: Ohio Health Group HMO |
$0.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.10
|
| Rate for Payer: United Healthcare All Payer |
$0.09
|
|
