|
MYRINGOTOMY(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
761P2418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.03 |
| Max. Negotiated Rate |
$219.82 |
| Rate for Payer: Aetna Commercial |
$215.53
|
| Rate for Payer: Ambetter Exchange |
$141.37
|
| Rate for Payer: Anthem Medicaid |
$83.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$141.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$141.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$169.64
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$219.82
|
| Rate for Payer: Healthspan PPO |
$191.19
|
| Rate for Payer: Humana Medicaid |
$83.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$141.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.69
|
| Rate for Payer: Molina Healthcare Passport |
$83.03
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$183.78
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$141.37
|
|
|
MYRINGOTOMY(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
360P1285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$256.78 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Ambetter Exchange |
$112.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.43
|
| Rate for Payer: Anthem Medicaid |
$58.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$112.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$112.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.49
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$256.78
|
| Rate for Payer: Healthspan PPO |
$230.38
|
| Rate for Payer: Humana Medicaid |
$58.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$112.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.17
|
| Rate for Payer: Molina Healthcare Passport |
$58.01
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$146.78
|
| Rate for Payer: UHCCP Medicaid |
$64.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$112.91
|
|
|
MYRINGOTOMY(T
|
Facility
|
OP
|
$1,752.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
360T1285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$1,681.92 |
| Rate for Payer: Aetna Commercial |
$1,349.04
|
| Rate for Payer: Anthem Medicaid |
$602.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cigna Commercial |
$1,454.16
|
| Rate for Payer: First Health Commercial |
$1,664.40
|
| Rate for Payer: Humana Commercial |
$1,489.20
|
| Rate for Payer: Humana KY Medicaid |
$602.51
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$608.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,292.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,208.88
|
| Rate for Payer: PHCS Commercial |
$1,681.92
|
| Rate for Payer: United Healthcare All Payer |
$1,541.76
|
|
|
MYRINGOTOMY(T
|
Facility
|
IP
|
$1,752.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
761T2417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.60 |
| Max. Negotiated Rate |
$1,681.92 |
| Rate for Payer: Aetna Commercial |
$1,349.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.56
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cigna Commercial |
$1,454.16
|
| Rate for Payer: First Health Commercial |
$1,664.40
|
| Rate for Payer: Humana Commercial |
$1,489.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,292.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,208.88
|
| Rate for Payer: PHCS Commercial |
$1,681.92
|
| Rate for Payer: United Healthcare All Payer |
$1,541.76
|
|
|
MYRINGOTOMY(T
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
761T2418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,290.31 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem Medicaid |
$1,290.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Humana KY Medicaid |
$1,290.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,303.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,316.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
MYRINGOTOMY(T
|
Facility
|
OP
|
$1,752.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
761T2417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.57 |
| Max. Negotiated Rate |
$1,681.92 |
| Rate for Payer: Aetna Commercial |
$1,349.04
|
| Rate for Payer: Anthem Medicaid |
$602.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cigna Commercial |
$1,454.16
|
| Rate for Payer: First Health Commercial |
$1,664.40
|
| Rate for Payer: Humana Commercial |
$1,489.20
|
| Rate for Payer: Humana KY Medicaid |
$602.51
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$608.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,292.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,208.88
|
| Rate for Payer: PHCS Commercial |
$1,681.92
|
| Rate for Payer: United Healthcare All Payer |
$1,541.76
|
|
|
MYRINGOTOMY(T
|
Facility
|
IP
|
$1,752.00
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
360T1285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$525.60 |
| Max. Negotiated Rate |
$1,681.92 |
| Rate for Payer: Aetna Commercial |
$1,349.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.56
|
| Rate for Payer: Cash Price |
$876.00
|
| Rate for Payer: Cigna Commercial |
$1,454.16
|
| Rate for Payer: First Health Commercial |
$1,664.40
|
| Rate for Payer: Humana Commercial |
$1,489.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,292.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,208.88
|
| Rate for Payer: PHCS Commercial |
$1,681.92
|
| Rate for Payer: United Healthcare All Payer |
$1,541.76
|
|
|
MYRINGOTOMY(T
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
761T2418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,125.60 |
| Max. Negotiated Rate |
$3,601.92 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
MYSOLINE (PRIMIDONE 250MG/1TAB
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
NDC 527123101
|
| Hospital Charge Code |
25001035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
MYSOLINE (PRIMIDONE 250MG/1TAB
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
NDC 527123101
|
| Hospital Charge Code |
25001035
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
MYSOLINE (PRIMIDONE) 50MG/1TAB
|
Facility
|
OP
|
$5.01
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
25001036
|
|
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
|
|
|
MYSOLINE (PRIMIDONE) 50MG/1TAB
|
Facility
|
IP
|
$5.01
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
25001036
|
|
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
|
|
|
MY WAY 1.5MG TABLET
|
Facility
|
OP
|
$30.50
|
|
|
Service Code
|
NDC 68180085211
|
| Hospital Charge Code |
25003879
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$29.28 |
| Rate for Payer: Aetna Commercial |
$23.48
|
| Rate for Payer: Anthem Medicaid |
$10.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.79
|
| Rate for Payer: Cash Price |
$15.25
|
| Rate for Payer: Cigna Commercial |
$25.32
|
| Rate for Payer: First Health Commercial |
$28.98
|
| Rate for Payer: Humana Commercial |
$25.93
|
| Rate for Payer: Humana KY Medicaid |
$10.49
|
| Rate for Payer: Kentucky WC Medicaid |
$10.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.84
|
| Rate for Payer: Ohio Health Group HMO |
$22.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.05
|
| Rate for Payer: PHCS Commercial |
$29.28
|
| Rate for Payer: United Healthcare All Payer |
$26.84
|
|
|
MY WAY 1.5MG TABLET
|
Facility
|
IP
|
$30.50
|
|
|
Service Code
|
NDC 68180085211
|
| Hospital Charge Code |
25003879
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$29.28 |
| Rate for Payer: Aetna Commercial |
$23.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.79
|
| Rate for Payer: Cash Price |
$15.25
|
| Rate for Payer: Cigna Commercial |
$25.32
|
| Rate for Payer: First Health Commercial |
$28.98
|
| Rate for Payer: Humana Commercial |
$25.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.84
|
| Rate for Payer: Ohio Health Group HMO |
$22.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.05
|
| Rate for Payer: PHCS Commercial |
$29.28
|
| Rate for Payer: United Healthcare All Payer |
$26.84
|
|
|
NaCl 0.9% IRRIGATION 1 L BAG
|
Facility
|
OP
|
$24.75
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
25004443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$23.76 |
| Rate for Payer: Aetna Commercial |
$19.06
|
| Rate for Payer: Anthem Medicaid |
$8.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.30
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cigna Commercial |
$20.54
|
| Rate for Payer: First Health Commercial |
$23.51
|
| Rate for Payer: Humana Commercial |
$21.04
|
| Rate for Payer: Humana KY Medicaid |
$8.51
|
| Rate for Payer: Kentucky WC Medicaid |
$8.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.78
|
| Rate for Payer: Ohio Health Group HMO |
$18.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.08
|
| Rate for Payer: PHCS Commercial |
$23.76
|
| Rate for Payer: United Healthcare All Payer |
$21.78
|
|
|
NaCl 0.9% IRRIGATION 1 L BAG
|
Facility
|
IP
|
$24.75
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
25004443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$23.76 |
| Rate for Payer: Aetna Commercial |
$19.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.30
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cigna Commercial |
$20.54
|
| Rate for Payer: First Health Commercial |
$23.51
|
| Rate for Payer: Humana Commercial |
$21.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.78
|
| Rate for Payer: Ohio Health Group HMO |
$18.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.08
|
| Rate for Payer: PHCS Commercial |
$23.76
|
| Rate for Payer: United Healthcare All Payer |
$21.78
|
|
|
NaCl 0.9% IRRIGATION 2 L BAG
|
Facility
|
OP
|
$86.10
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
25002789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.83 |
| Max. Negotiated Rate |
$82.66 |
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Anthem Medicaid |
$29.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cigna Commercial |
$71.46
|
| Rate for Payer: First Health Commercial |
$81.80
|
| Rate for Payer: Humana Commercial |
$73.19
|
| Rate for Payer: Humana KY Medicaid |
$29.61
|
| Rate for Payer: Kentucky WC Medicaid |
$29.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.77
|
| Rate for Payer: Ohio Health Group HMO |
$64.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.41
|
| Rate for Payer: PHCS Commercial |
$82.66
|
| Rate for Payer: United Healthcare All Payer |
$75.77
|
|
|
NaCl 0.9% IRRIGATION 2 L BAG
|
Facility
|
IP
|
$86.10
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
25002789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.83 |
| Max. Negotiated Rate |
$82.66 |
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.16
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cigna Commercial |
$71.46
|
| Rate for Payer: First Health Commercial |
$81.80
|
| Rate for Payer: Humana Commercial |
$73.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.77
|
| Rate for Payer: Ohio Health Group HMO |
$64.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.41
|
| Rate for Payer: PHCS Commercial |
$82.66
|
| Rate for Payer: United Healthcare All Payer |
$75.77
|
|
|
NACL 0.9% RESP. NEB (15ML)
|
Facility
|
OP
|
$4.99
|
|
|
Service Code
|
NDC 378698789
|
| Hospital Charge Code |
25001037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Anthem Medicaid |
$1.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.89
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.14
|
| Rate for Payer: First Health Commercial |
$4.74
|
| Rate for Payer: Humana Commercial |
$4.24
|
| Rate for Payer: Humana KY Medicaid |
$1.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.39
|
| Rate for Payer: Ohio Health Group HMO |
$3.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.44
|
| Rate for Payer: PHCS Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Payer |
$4.39
|
|
|
NACL 0.9% RESP. NEB (15ML)
|
Facility
|
IP
|
$4.99
|
|
|
Service Code
|
NDC 378698789
|
| Hospital Charge Code |
25001037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.89
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.14
|
| Rate for Payer: First Health Commercial |
$4.74
|
| Rate for Payer: Humana Commercial |
$4.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.39
|
| Rate for Payer: Ohio Health Group HMO |
$3.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.44
|
| Rate for Payer: PHCS Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Payer |
$4.39
|
|
|
NaCl 3% 1mL (0.513 mEq/mL)
|
Facility
|
OP
|
$113.35
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25004133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$108.82 |
| Rate for Payer: Aetna Commercial |
$87.28
|
| Rate for Payer: Anthem Medicaid |
$38.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.41
|
| Rate for Payer: Cash Price |
$56.67
|
| Rate for Payer: Cigna Commercial |
$94.08
|
| Rate for Payer: First Health Commercial |
$107.68
|
| Rate for Payer: Humana Commercial |
$96.35
|
| Rate for Payer: Humana KY Medicaid |
$38.98
|
| Rate for Payer: Kentucky WC Medicaid |
$39.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.75
|
| Rate for Payer: Ohio Health Group HMO |
$85.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.21
|
| Rate for Payer: PHCS Commercial |
$108.82
|
| Rate for Payer: United Healthcare All Payer |
$99.75
|
|
|
NaCl 3% 1mL (0.513 mEq/mL)
|
Facility
|
IP
|
$113.35
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25004133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$108.82 |
| Rate for Payer: Aetna Commercial |
$87.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.41
|
| Rate for Payer: Cash Price |
$56.67
|
| Rate for Payer: Cigna Commercial |
$94.08
|
| Rate for Payer: First Health Commercial |
$107.68
|
| Rate for Payer: Humana Commercial |
$96.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.75
|
| Rate for Payer: Ohio Health Group HMO |
$85.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.21
|
| Rate for Payer: PHCS Commercial |
$108.82
|
| Rate for Payer: United Healthcare All Payer |
$99.75
|
|
|
NaCl 3% 1mL (3 mg/mL)
|
Facility
|
IP
|
$113.35
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25004134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$108.82 |
| Rate for Payer: Aetna Commercial |
$87.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.41
|
| Rate for Payer: Cash Price |
$56.67
|
| Rate for Payer: Cigna Commercial |
$94.08
|
| Rate for Payer: First Health Commercial |
$107.68
|
| Rate for Payer: Humana Commercial |
$96.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.75
|
| Rate for Payer: Ohio Health Group HMO |
$85.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.21
|
| Rate for Payer: PHCS Commercial |
$108.82
|
| Rate for Payer: United Healthcare All Payer |
$99.75
|
|
|
NaCl 3% 1mL (3 mg/mL)
|
Facility
|
OP
|
$113.35
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25004134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$108.82 |
| Rate for Payer: Aetna Commercial |
$87.28
|
| Rate for Payer: Anthem Medicaid |
$38.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.41
|
| Rate for Payer: Cash Price |
$56.67
|
| Rate for Payer: Cigna Commercial |
$94.08
|
| Rate for Payer: First Health Commercial |
$107.68
|
| Rate for Payer: Humana Commercial |
$96.35
|
| Rate for Payer: Humana KY Medicaid |
$38.98
|
| Rate for Payer: Kentucky WC Medicaid |
$39.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.75
|
| Rate for Payer: Ohio Health Group HMO |
$85.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.21
|
| Rate for Payer: PHCS Commercial |
$108.82
|
| Rate for Payer: United Healthcare All Payer |
$99.75
|
|
|
NAFCILLIN 1gm/54mL BAG (ANES)
|
Facility
|
IP
|
$120.97
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
25004162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.29 |
| Max. Negotiated Rate |
$116.13 |
| Rate for Payer: Aetna Commercial |
$93.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.36
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cigna Commercial |
$100.41
|
| Rate for Payer: First Health Commercial |
$114.92
|
| Rate for Payer: Humana Commercial |
$102.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.45
|
| Rate for Payer: Ohio Health Group HMO |
$90.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.47
|
| Rate for Payer: PHCS Commercial |
$116.13
|
| Rate for Payer: United Healthcare All Payer |
$106.45
|
|
