|
PULM FUNCT TST PLETHYSMOGRA(T
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
460T0012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$680.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$689.52
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$733.72
|
| Rate for Payer: First Health Commercial |
$839.80
|
| Rate for Payer: Humana Commercial |
$751.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$724.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$652.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$777.92
|
| Rate for Payer: Ohio Health Group HMO |
$663.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$707.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.96
|
| Rate for Payer: PHCS Commercial |
$848.64
|
| Rate for Payer: United Healthcare All Payer |
$777.92
|
|
|
PULM FUNCT TST PLETHYSMOGRA(T
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
460T0012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$680.68
|
| Rate for Payer: Anthem Medicaid |
$304.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$689.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$733.72
|
| Rate for Payer: First Health Commercial |
$839.80
|
| Rate for Payer: Humana Commercial |
$751.40
|
| Rate for Payer: Humana KY Medicaid |
$304.01
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$307.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$724.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$652.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$310.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$777.92
|
| Rate for Payer: Ohio Health Group HMO |
$663.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$707.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.96
|
| Rate for Payer: PHCS Commercial |
$848.64
|
| Rate for Payer: United Healthcare All Payer |
$777.92
|
|
|
PULMICORT 0.5MG/2ML NEB
|
Facility
|
OP
|
$26.30
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
25001276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.89 |
| 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 |
$19.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.15
|
| Rate for Payer: PHCS Commercial |
$25.25
|
| Rate for Payer: United Healthcare All Payer |
$23.14
|
|
|
PULMICORT 0.5MG/2ML NEB
|
Facility
|
IP
|
$26.30
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
25001276
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.89 |
| 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 |
$19.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.15
|
| Rate for Payer: PHCS Commercial |
$25.25
|
| Rate for Payer: United Healthcare All Payer |
$23.14
|
|
|
PULMICORT FLEXHALER 120 PUFF
|
Facility
|
OP
|
$5.55
|
|
|
Service Code
|
NDC 186091612
|
| Hospital Charge Code |
25003976
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| 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 |
$1.67
|
| 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 |
$4.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.83
|
| Rate for Payer: PHCS Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Payer |
$4.88
|
|
|
PULMICORT FLEXHALER 120 PUFF
|
Facility
|
IP
|
$5.55
|
|
|
Service Code
|
NDC 186091612
|
| Hospital Charge Code |
25003976
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| 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 |
$1.67
|
| 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 |
$4.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.83
|
| 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 |
$3.08 |
| 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 |
$8.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.08
|
| 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 |
$3.08 |
| 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 |
$8.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.08
|
| Rate for Payer: PHCS Commercial |
$9.85
|
| Rate for Payer: United Healthcare All Payer |
$9.03
|
|
|
PULMOCARE
|
Facility
|
OP
|
$73.15
|
|
|
Service Code
|
NDC 70074062726
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.95 |
| 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 |
$21.95
|
| 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 |
$58.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.47
|
| Rate for Payer: PHCS Commercial |
$70.22
|
| Rate for Payer: United Healthcare All Payer |
$64.37
|
|
|
PULMOCARE
|
Facility
|
IP
|
$91.19
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.36 |
| 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 |
$72.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.92
|
| 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 |
$21.95 |
| 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 |
$21.95
|
| 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 |
$58.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.47
|
| 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 |
$27.36 |
| 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 |
$72.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.92
|
| Rate for Payer: PHCS Commercial |
$87.54
|
| Rate for Payer: United Healthcare All Payer |
$80.25
|
|
|
PULMOCARE (TF) 8 OZ CAN
|
Facility
|
IP
|
$65.36
|
|
|
Service Code
|
NDC 70074040699
|
| Hospital Charge Code |
25003396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.61 |
| 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 |
$52.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.10
|
| 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 |
$19.61 |
| 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 |
$52.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.10
|
| Rate for Payer: PHCS Commercial |
$62.75
|
| Rate for Payer: United Healthcare All Payer |
$57.52
|
|
|
PULMONARY ANGIO UNILATERAL
|
Facility
|
OP
|
$4,782.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
32000386
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,644.53 |
| Max. Negotiated Rate |
$4,590.72 |
| Rate for Payer: Aetna Commercial |
$3,682.14
|
| Rate for Payer: Anthem Medicaid |
$1,644.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,729.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,391.00
|
| Rate for Payer: Cash Price |
$2,391.00
|
| Rate for Payer: Cigna Commercial |
$3,969.06
|
| Rate for Payer: First Health Commercial |
$4,542.90
|
| Rate for Payer: Humana Commercial |
$4,064.70
|
| Rate for Payer: Humana KY Medicaid |
$1,644.53
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,661.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,677.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,825.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.58
|
| Rate for Payer: PHCS Commercial |
$4,590.72
|
| Rate for Payer: United Healthcare All Payer |
$4,208.16
|
|
|
PULMONARY ANGIO UNILATERAL
|
Facility
|
IP
|
$4,782.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
32000386
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,434.60 |
| Max. Negotiated Rate |
$4,590.72 |
| Rate for Payer: Aetna Commercial |
$3,682.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,729.96
|
| Rate for Payer: Cash Price |
$2,391.00
|
| Rate for Payer: Cigna Commercial |
$3,969.06
|
| Rate for Payer: First Health Commercial |
$4,542.90
|
| Rate for Payer: Humana Commercial |
$4,064.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,825.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.58
|
| Rate for Payer: PHCS Commercial |
$4,590.72
|
| Rate for Payer: United Healthcare All Payer |
$4,208.16
|
|
|
PULMONARY ARTERIES - BILATERAL
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
320P0161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$717.72 |
| Rate for Payer: Aetna Commercial |
$468.72
|
| Rate for Payer: Ambetter Exchange |
$135.91
|
| Rate for Payer: Anthem Medicaid |
$411.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$135.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.09
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$135.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.81
|
| Rate for Payer: Molina Healthcare Passport |
$411.58
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$176.68
|
| Rate for Payer: UHCCP Medicaid |
$98.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$415.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$135.91
|
|
|
PULMONARY ARTERIES - BILATERAL
|
Facility
|
OP
|
$4,900.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
32000161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,685.11 |
| Max. Negotiated Rate |
$4,704.00 |
| Rate for Payer: Aetna Commercial |
$3,773.00
|
| Rate for Payer: Anthem Medicaid |
$1,685.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,450.00
|
| 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: Humana KY Medicaid |
$1,685.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.26
|
| 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 |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,718.92
|
| 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 |
$3,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,263.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,381.00
|
| Rate for Payer: PHCS Commercial |
$4,704.00
|
| Rate for Payer: United Healthcare All Payer |
$4,312.00
|
|
|
PULMONARY ARTERIES - BILATERAL
|
Facility
|
IP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
320T0161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,386.00 |
| 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 |
$3,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,019.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,187.80
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
PULMONARY ARTERIES - BILATERAL
|
Facility
|
IP
|
$4,900.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
32000161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,470.00 |
| 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 |
$3,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,263.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,381.00
|
| Rate for Payer: PHCS Commercial |
$4,704.00
|
| Rate for Payer: United Healthcare All Payer |
$4,312.00
|
|
|
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 |
$2,940.00 |
| Rate for Payer: Aetna Commercial |
$468.72
|
| Rate for Payer: Ambetter Exchange |
$135.91
|
| Rate for Payer: Anthem Medicaid |
$411.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$135.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.09
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$135.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.91
|
| 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 |
$176.68
|
| Rate for Payer: UHCCP Medicaid |
$1,715.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$415.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$135.91
|
|
|
PULMONARY ARTERIES - BILATERAL
|
Facility
|
OP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
320T0161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,588.82 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$3,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,019.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,187.80
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
PULMONARY ARTERIES BILATERAL
|
Facility
|
IP
|
$4,921.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
32000387
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,476.30 |
| Max. Negotiated Rate |
$4,724.16 |
| Rate for Payer: Aetna Commercial |
$3,789.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,838.38
|
| Rate for Payer: Cash Price |
$2,460.50
|
| Rate for Payer: Cigna Commercial |
$4,084.43
|
| Rate for Payer: First Health Commercial |
$4,674.95
|
| Rate for Payer: Humana Commercial |
$4,182.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,035.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,631.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,476.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,330.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,690.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,936.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,281.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,395.49
|
| Rate for Payer: PHCS Commercial |
$4,724.16
|
| Rate for Payer: United Healthcare All Payer |
$4,330.48
|
|
|
PULMONARY ARTERIES BILATERAL
|
Facility
|
OP
|
$4,921.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
32000387
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$1,692.33 |
| Max. Negotiated Rate |
$4,724.16 |
| Rate for Payer: Aetna Commercial |
$3,789.17
|
| Rate for Payer: Anthem Medicaid |
$1,692.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,838.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,460.50
|
| Rate for Payer: Cash Price |
$2,460.50
|
| Rate for Payer: Cigna Commercial |
$4,084.43
|
| Rate for Payer: First Health Commercial |
$4,674.95
|
| Rate for Payer: Humana Commercial |
$4,182.85
|
| Rate for Payer: Humana KY Medicaid |
$1,692.33
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,709.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,035.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,631.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,726.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,330.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,690.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,936.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,281.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,395.49
|
| Rate for Payer: PHCS Commercial |
$4,724.16
|
| Rate for Payer: United Healthcare All Payer |
$4,330.48
|
|
|
PULMOZYME SOL I 2.5ML
|
Facility
|
IP
|
$303.77
|
|
|
Service Code
|
HCPCS J7639
|
| Hospital Charge Code |
25002516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.13 |
| Max. Negotiated Rate |
$291.62 |
| Rate for Payer: Aetna Commercial |
$233.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$236.94
|
| Rate for Payer: Cash Price |
$151.88
|
| Rate for Payer: Cigna Commercial |
$252.13
|
| Rate for Payer: First Health Commercial |
$288.58
|
| Rate for Payer: Humana Commercial |
$258.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.32
|
| Rate for Payer: Ohio Health Group HMO |
$227.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.60
|
| Rate for Payer: PHCS Commercial |
$291.62
|
| Rate for Payer: United Healthcare All Payer |
$267.32
|
|
