|
PULM FUNCT TEST OSCILLOMETRY
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$432.96 |
| Rate for Payer: Aetna Commercial |
$347.27
|
| Rate for Payer: Anthem Medicaid |
$155.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$374.33
|
| Rate for Payer: First Health Commercial |
$428.45
|
| Rate for Payer: Humana Commercial |
$383.35
|
| Rate for Payer: Humana KY Medicaid |
$155.10
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$156.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.88
|
| Rate for Payer: Ohio Health Group HMO |
$338.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.81
|
| Rate for Payer: PHCS Commercial |
$432.96
|
| Rate for Payer: United Healthcare All Payer |
$396.88
|
|
|
PULM FUNCT TEST OSCILLOMETRY
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$432.96 |
| Rate for Payer: Aetna Commercial |
$347.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.78
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$374.33
|
| Rate for Payer: First Health Commercial |
$428.45
|
| Rate for Payer: Humana Commercial |
$383.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.88
|
| Rate for Payer: Ohio Health Group HMO |
$338.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.81
|
| Rate for Payer: PHCS Commercial |
$432.96
|
| Rate for Payer: United Healthcare All Payer |
$396.88
|
|
|
PULM FUNCT TST PLETHYSMOGRA(P
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
460P0012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Anthem Medicaid |
$41.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$88.27
|
| Rate for Payer: Healthspan PPO |
$45.66
|
| Rate for Payer: Humana Medicaid |
$41.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.33
|
| Rate for Payer: Molina Healthcare Passport |
$41.50
|
| Rate for Payer: Multiplan PHCS |
$57.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$67.20
|
| Rate for Payer: UHCCP Medicaid |
$33.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.92
|
|
|
PULM FUNCT TST PLETHYSMOGRAP
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$898.00 |
| Rate for Payer: Anthem Medicaid |
$41.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$898.00
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cigna Commercial |
$88.27
|
| Rate for Payer: Healthspan PPO |
$45.66
|
| Rate for Payer: Humana Medicaid |
$41.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.33
|
| Rate for Payer: Molina Healthcare Passport |
$41.50
|
| Rate for Payer: Multiplan PHCS |
$538.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$628.60
|
| Rate for Payer: UHCCP Medicaid |
$314.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.92
|
|
|
PULM FUNCT TST PLETHYSMOGRAP
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$691.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$700.44
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cigna Commercial |
$745.34
|
| Rate for Payer: First Health Commercial |
$853.10
|
| Rate for Payer: Humana Commercial |
$763.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$736.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$662.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$790.24
|
| Rate for Payer: Ohio Health Group HMO |
$673.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.38
|
| Rate for Payer: PHCS Commercial |
$862.08
|
| Rate for Payer: United Healthcare All Payer |
$790.24
|
|
|
PULM FUNCT TST PLETHYSMOGRAP
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$691.46
|
| Rate for Payer: Anthem Medicaid |
$308.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$700.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cash Price |
$449.00
|
| Rate for Payer: Cigna Commercial |
$745.34
|
| Rate for Payer: First Health Commercial |
$853.10
|
| Rate for Payer: Humana Commercial |
$763.30
|
| Rate for Payer: Humana KY Medicaid |
$308.82
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$311.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$736.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$662.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$790.24
|
| Rate for Payer: Ohio Health Group HMO |
$673.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.38
|
| Rate for Payer: PHCS Commercial |
$862.08
|
| Rate for Payer: United Healthcare All Payer |
$790.24
|
|
|
PULM FUNCT TST PLETHYSMOGRA(T
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
460T0012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$107.90 |
| Max. Negotiated Rate |
$796.80 |
| Rate for Payer: Aetna Commercial |
$639.10
|
| Rate for Payer: Anthem Medicaid |
$285.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$647.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$688.90
|
| Rate for Payer: First Health Commercial |
$788.50
|
| Rate for Payer: Humana Commercial |
$705.50
|
| Rate for Payer: Humana KY Medicaid |
$285.44
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$288.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$680.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$612.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$291.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$730.40
|
| Rate for Payer: Ohio Health Group HMO |
$622.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.30
|
| Rate for Payer: PHCS Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Payer |
$730.40
|
|
|
PULM FUNCT TST PLETHYSMOGRA(T
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
460T0012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$107.90 |
| Max. Negotiated Rate |
$796.80 |
| Rate for Payer: Aetna Commercial |
$639.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$647.40
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$688.90
|
| Rate for Payer: First Health Commercial |
$788.50
|
| Rate for Payer: Humana Commercial |
$705.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$680.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$612.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$730.40
|
| Rate for Payer: Ohio Health Group HMO |
$622.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.30
|
| Rate for Payer: PHCS Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Payer |
$730.40
|
|
|
PULMICORT 0.5MG/2ML NEB
|
Facility
|
IP
|
$26.30
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
25001276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$25.25 |
| Rate for Payer: Aetna Commercial |
$20.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.51
|
| Rate for Payer: Cash Price |
$13.15
|
| Rate for Payer: Cigna Commercial |
$21.83
|
| Rate for Payer: First Health Commercial |
$24.98
|
| Rate for Payer: Humana Commercial |
$22.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.14
|
| Rate for Payer: Ohio Health Group HMO |
$19.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.15
|
| Rate for Payer: PHCS Commercial |
$25.25
|
| Rate for Payer: United Healthcare All Payer |
$23.14
|
|
|
PULMICORT 0.5MG/2ML NEB
|
Facility
|
OP
|
$26.30
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
25001276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$25.25 |
| Rate for Payer: Aetna Commercial |
$20.25
|
| Rate for Payer: Anthem Medicaid |
$9.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.51
|
| Rate for Payer: Cash Price |
$13.15
|
| Rate for Payer: Cigna Commercial |
$21.83
|
| Rate for Payer: First Health Commercial |
$24.98
|
| Rate for Payer: Humana Commercial |
$22.36
|
| Rate for Payer: Humana KY Medicaid |
$9.04
|
| Rate for Payer: Kentucky WC Medicaid |
$9.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.14
|
| Rate for Payer: Ohio Health Group HMO |
$19.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.15
|
| Rate for Payer: PHCS Commercial |
$25.25
|
| Rate for Payer: United Healthcare All Payer |
$23.14
|
|
|
PULMICORT FLEXHALER 120 PUFF
|
Facility
|
IP
|
$5.55
|
|
|
Service Code
|
NDC 186091612
|
| Hospital Charge Code |
25003976
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.33 |
| Rate for Payer: Aetna Commercial |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.33
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: First Health Commercial |
$5.27
|
| Rate for Payer: Humana Commercial |
$4.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.88
|
| Rate for Payer: Ohio Health Group HMO |
$4.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.72
|
| Rate for Payer: PHCS Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Payer |
$4.88
|
|
|
PULMICORT FLEXHALER 120 PUFF
|
Facility
|
OP
|
$5.55
|
|
|
Service Code
|
NDC 186091612
|
| Hospital Charge Code |
25003976
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$5.33 |
| Rate for Payer: Aetna Commercial |
$4.27
|
| Rate for Payer: Anthem Medicaid |
$1.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.33
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna Commercial |
$4.61
|
| Rate for Payer: First Health Commercial |
$5.27
|
| Rate for Payer: Humana Commercial |
$4.72
|
| Rate for Payer: Humana KY Medicaid |
$1.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.88
|
| Rate for Payer: Ohio Health Group HMO |
$4.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.72
|
| Rate for Payer: PHCS Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Payer |
$4.88
|
|
|
PULMICORT FLEXHALER 90MCG INH
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 186091706
|
| Hospital Charge Code |
25003395
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Anthem Medicaid |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.00
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna Commercial |
$8.52
|
| Rate for Payer: First Health Commercial |
$9.75
|
| Rate for Payer: Humana Commercial |
$8.72
|
| Rate for Payer: Humana KY Medicaid |
$3.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.03
|
| Rate for Payer: Ohio Health Group HMO |
$7.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$9.85
|
| Rate for Payer: United Healthcare All Payer |
$9.03
|
|
|
PULMICORT FLEXHALER 90MCG INH
|
Facility
|
IP
|
$10.26
|
|
|
Service Code
|
NDC 186091706
|
| Hospital Charge Code |
25003395
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$9.85 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.00
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cigna Commercial |
$8.52
|
| Rate for Payer: First Health Commercial |
$9.75
|
| Rate for Payer: Humana Commercial |
$8.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.03
|
| Rate for Payer: Ohio Health Group HMO |
$7.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$9.85
|
| Rate for Payer: United Healthcare All Payer |
$9.03
|
|
|
PULMOCARE
|
Facility
|
IP
|
$91.19
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$87.54 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.13
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cigna Commercial |
$75.69
|
| Rate for Payer: First Health Commercial |
$86.63
|
| Rate for Payer: Humana Commercial |
$77.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.25
|
| Rate for Payer: Ohio Health Group HMO |
$68.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.27
|
| Rate for Payer: PHCS Commercial |
$87.54
|
| Rate for Payer: United Healthcare All Payer |
$80.25
|
|
|
PULMOCARE
|
Facility
|
OP
|
$73.15
|
|
|
Service Code
|
NDC 70074062726
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$70.22 |
| Rate for Payer: Aetna Commercial |
$56.33
|
| Rate for Payer: Anthem Medicaid |
$25.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.06
|
| Rate for Payer: Cash Price |
$36.58
|
| Rate for Payer: Cigna Commercial |
$60.71
|
| Rate for Payer: First Health Commercial |
$69.49
|
| Rate for Payer: Humana Commercial |
$62.18
|
| Rate for Payer: Humana KY Medicaid |
$25.16
|
| Rate for Payer: Kentucky WC Medicaid |
$25.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.37
|
| Rate for Payer: Ohio Health Group HMO |
$54.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.68
|
| Rate for Payer: PHCS Commercial |
$70.22
|
| Rate for Payer: United Healthcare All Payer |
$64.37
|
|
|
PULMOCARE
|
Facility
|
OP
|
$91.19
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$87.54 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Anthem Medicaid |
$31.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.13
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cigna Commercial |
$75.69
|
| Rate for Payer: First Health Commercial |
$86.63
|
| Rate for Payer: Humana Commercial |
$77.51
|
| Rate for Payer: Humana KY Medicaid |
$31.36
|
| Rate for Payer: Kentucky WC Medicaid |
$31.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.25
|
| Rate for Payer: Ohio Health Group HMO |
$68.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.27
|
| Rate for Payer: PHCS Commercial |
$87.54
|
| Rate for Payer: United Healthcare All Payer |
$80.25
|
|
|
PULMOCARE
|
Facility
|
IP
|
$73.15
|
|
|
Service Code
|
NDC 70074062726
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$70.22 |
| Rate for Payer: Aetna Commercial |
$56.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.06
|
| Rate for Payer: Cash Price |
$36.58
|
| Rate for Payer: Cigna Commercial |
$60.71
|
| Rate for Payer: First Health Commercial |
$69.49
|
| Rate for Payer: Humana Commercial |
$62.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.37
|
| Rate for Payer: Ohio Health Group HMO |
$54.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.68
|
| Rate for Payer: PHCS Commercial |
$70.22
|
| Rate for Payer: United Healthcare All Payer |
$64.37
|
|
|
PULMOCARE (TF) 8 OZ CAN
|
Facility
|
IP
|
$65.36
|
|
|
Service Code
|
NDC 70074040699
|
| Hospital Charge Code |
25003396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$62.75 |
| Rate for Payer: Aetna Commercial |
$50.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.98
|
| Rate for Payer: Cash Price |
$32.68
|
| Rate for Payer: Cigna Commercial |
$54.25
|
| Rate for Payer: First Health Commercial |
$62.09
|
| Rate for Payer: Humana Commercial |
$55.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.52
|
| Rate for Payer: Ohio Health Group HMO |
$49.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.26
|
| Rate for Payer: PHCS Commercial |
$62.75
|
| Rate for Payer: United Healthcare All Payer |
$57.52
|
|
|
PULMOCARE (TF) 8 OZ CAN
|
Facility
|
OP
|
$65.36
|
|
|
Service Code
|
NDC 70074040699
|
| Hospital Charge Code |
25003396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$62.75 |
| Rate for Payer: Aetna Commercial |
$50.33
|
| Rate for Payer: Anthem Medicaid |
$22.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.98
|
| Rate for Payer: Cash Price |
$32.68
|
| Rate for Payer: Cigna Commercial |
$54.25
|
| Rate for Payer: First Health Commercial |
$62.09
|
| Rate for Payer: Humana Commercial |
$55.56
|
| Rate for Payer: Humana KY Medicaid |
$22.48
|
| Rate for Payer: Kentucky WC Medicaid |
$22.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.52
|
| Rate for Payer: Ohio Health Group HMO |
$49.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.26
|
| Rate for Payer: PHCS Commercial |
$62.75
|
| Rate for Payer: United Healthcare All Payer |
$57.52
|
|
|
PULMONARY ANGIO UNILATERAL
|
Facility
|
OP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
32000386
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem Medicaid |
$1,588.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Humana KY Medicaid |
$1,588.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,604.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,620.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.20
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
PULMONARY ANGIO UNILATERAL
|
Facility
|
IP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
32000386
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,386.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.20
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
PULMONARY ARTERIES - BILATERAL
|
Professional
|
Both
|
$4,900.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
32000161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.48 |
| Max. Negotiated Rate |
$4,900.00 |
| Rate for Payer: Aetna Commercial |
$468.72
|
| Rate for Payer: Anthem Medicaid |
$411.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,900.00
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cigna Commercial |
$717.72
|
| Rate for Payer: Healthspan PPO |
$439.20
|
| Rate for Payer: Humana Medicaid |
$411.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.81
|
| Rate for Payer: Molina Healthcare Passport |
$411.58
|
| Rate for Payer: Multiplan PHCS |
$2,940.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,430.00
|
| Rate for Payer: UHCCP Medicaid |
$1,715.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$415.70
|
|
|
PULMONARY ARTERIES - BILATERAL
|
Facility
|
IP
|
$4,900.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
32000161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$637.00 |
| Max. Negotiated Rate |
$4,704.00 |
| Rate for Payer: Aetna Commercial |
$3,773.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.00
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cigna Commercial |
$4,067.00
|
| Rate for Payer: First Health Commercial |
$4,655.00
|
| Rate for Payer: Humana Commercial |
$4,165.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.00
|
| Rate for Payer: PHCS Commercial |
$4,704.00
|
| Rate for Payer: United Healthcare All Payer |
$4,312.00
|
|
|
PULMONARY ARTERIES - BILATERAL
|
Facility
|
OP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
320T0161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem Medicaid |
$1,588.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Humana KY Medicaid |
$1,588.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,604.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,620.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.20
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
