|
HYCAMTIN 0.1 MG ( 4MG VIAL)
|
Facility
|
OP
|
$1,280.75
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
25002683
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$384.23 |
| Max. Negotiated Rate |
$1,229.52 |
| Rate for Payer: Aetna Commercial |
$986.18
|
| Rate for Payer: Anthem Medicaid |
$440.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.99
|
| Rate for Payer: Cash Price |
$640.38
|
| Rate for Payer: Cigna Commercial |
$1,063.02
|
| Rate for Payer: First Health Commercial |
$1,216.71
|
| Rate for Payer: Humana Commercial |
$1,088.64
|
| Rate for Payer: Humana KY Medicaid |
$440.45
|
| Rate for Payer: Kentucky WC Medicaid |
$444.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,050.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$945.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,127.06
|
| Rate for Payer: Ohio Health Group HMO |
$960.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.72
|
| Rate for Payer: PHCS Commercial |
$1,229.52
|
| Rate for Payer: United Healthcare All Payer |
$1,127.06
|
|
|
HYDRATING CLEANSER 200 ML GBL
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
22200141
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$15.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$15.48
|
| Rate for Payer: Kentucky WC Medicaid |
$15.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
HYDRATING CLEANSER 200 ML GBL
|
Professional
|
Both
|
$45.00
|
|
| Hospital Charge Code |
22200141
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
|
|
HYDRATING CLEANSER 200 ML GBL
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
22200141
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
HYDRATION ADDL HRS EA
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Aetna Commercial |
$25.71
|
| Rate for Payer: Ambetter Exchange |
$10.91
|
| Rate for Payer: Anthem Medicaid |
$13.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.09
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$22.41
|
| Rate for Payer: Healthspan PPO |
$24.09
|
| Rate for Payer: Humana Medicaid |
$13.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$10.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$13.31
|
| Rate for Payer: Molina Healthcare Passport |
$13.05
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.18
|
| Rate for Payer: UHCCP Medicaid |
$75.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$13.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.91
|
|
|
HYDRATION ADDL HRS EA
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem Medicaid |
$73.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Humana KY Medicaid |
$73.94
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$74.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.35
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
HYDRATION ADDL HRS EA
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.70
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.35
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
HYDRATION INIT INFUS 1HR
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
HYDRATION INIT INFUS 1HR
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$133.43 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem Medicaid |
$133.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$194.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$272.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.80
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Humana KY Medicaid |
$133.43
|
| Rate for Payer: Humana Medicare Advantage |
$194.67
|
| Rate for Payer: Kentucky WC Medicaid |
$134.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
HYDRATION INIT INFUS 1HR
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$232.80 |
| Rate for Payer: Aetna Commercial |
$85.98
|
| Rate for Payer: Ambetter Exchange |
$27.93
|
| Rate for Payer: Anthem Medicaid |
$45.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$27.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$27.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.52
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$75.95
|
| Rate for Payer: Healthspan PPO |
$80.56
|
| Rate for Payer: Humana Medicaid |
$45.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$27.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.31
|
| Rate for Payer: Molina Healthcare Passport |
$45.40
|
| Rate for Payer: Multiplan PHCS |
$232.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.31
|
| Rate for Payer: UHCCP Medicaid |
$135.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.93
|
|
|
HYDREA (HYDROXYUREA 500MG/1CAP
|
Facility
|
IP
|
$5.01
|
|
|
Service Code
|
NDC 68084028401
|
| Hospital Charge Code |
25000755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| 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 |
$4.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.46
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
|
|
HYDREA (HYDROXYUREA 500MG/1CAP
|
Facility
|
OP
|
$5.01
|
|
|
Service Code
|
NDC 68084028401
|
| Hospital Charge Code |
25000755
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| 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 |
$4.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.46
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
|
|
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 |
$19.04 |
| 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 |
$50.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.79
|
| Rate for Payer: PHCS Commercial |
$60.93
|
| Rate for Payer: United Healthcare All Payer |
$55.85
|
|
|
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 |
$19.04 |
| 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 |
$50.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.79
|
| 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 |
$19.40 |
| 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 |
$48.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.62
|
| 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 |
$19.40 |
| 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 |
$48.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.62
|
| Rate for Payer: PHCS Commercial |
$62.07
|
| Rate for Payer: United Healthcare All Payer |
$56.90
|
|
|
HYDROCORTISONE 1% CREAM 3 30GM
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 45802043803
|
| Hospital Charge Code |
25000758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.02 |
| 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 |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.06
|
| Rate for Payer: PHCS Commercial |
$0.08
|
| Rate for Payer: United Healthcare All Payer |
$0.07
|
|
|
HYDROCORTISONE 1% CREAM 3 30GM
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 45802043803
|
| Hospital Charge Code |
25000758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.02 |
| 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 |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.06
|
| 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 |
$0.87 |
| 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 |
$2.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.01
|
| 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 |
$0.87 |
| 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 |
$2.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.01
|
| Rate for Payer: PHCS Commercial |
$2.79
|
| Rate for Payer: United Healthcare All Payer |
$2.56
|
|
|
HYDROCORTISONE 2.5% CREAM 30GM
|
Facility
|
OP
|
$1.73
|
|
|
Service Code
|
NDC 51672300302
|
| Hospital Charge Code |
25000760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.52 |
| 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 |
$1.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.19
|
| Rate for Payer: PHCS Commercial |
$1.66
|
| Rate for Payer: United Healthcare All Payer |
$1.52
|
|
|
HYDROCORTISONE 2.5% CREAM 30GM
|
Facility
|
IP
|
$1.73
|
|
|
Service Code
|
NDC 51672300302
|
| Hospital Charge Code |
25000760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.52 |
| 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 |
$1.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.19
|
| 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 |
$1.32 |
| 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 |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| 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 |
$1.32 |
| 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 |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| 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 |
$1.43 |
| 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 |
$3.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.28
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
