|
ASPIRATION BREAST
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.30 |
| Max. Negotiated Rate |
$1,076.16 |
| Rate for Payer: Aetna Commercial |
$863.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$874.38
|
| Rate for Payer: Cash Price |
$560.50
|
| Rate for Payer: Cigna Commercial |
$930.43
|
| Rate for Payer: First Health Commercial |
$1,064.95
|
| Rate for Payer: Humana Commercial |
$952.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$919.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$827.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$986.48
|
| Rate for Payer: Ohio Health Group HMO |
$840.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$975.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$773.49
|
| Rate for Payer: PHCS Commercial |
$1,076.16
|
| Rate for Payer: United Healthcare All Payer |
$986.48
|
|
|
ASPIRATION BREAST
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
45000083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
ASPIRATION BREAST
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
45000083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$333.58 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem Medicaid |
$333.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Humana KY Medicaid |
$333.58
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$336.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$340.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
ASPIRATION BREAST
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.51 |
| Max. Negotiated Rate |
$1,076.16 |
| Rate for Payer: Aetna Commercial |
$863.17
|
| Rate for Payer: Anthem Medicaid |
$385.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$874.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$560.50
|
| Rate for Payer: Cash Price |
$560.50
|
| Rate for Payer: Cigna Commercial |
$930.43
|
| Rate for Payer: First Health Commercial |
$1,064.95
|
| Rate for Payer: Humana Commercial |
$952.85
|
| Rate for Payer: Humana KY Medicaid |
$385.51
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$389.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$919.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$827.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$393.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$986.48
|
| Rate for Payer: Ohio Health Group HMO |
$840.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$975.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$773.49
|
| Rate for Payer: PHCS Commercial |
$1,076.16
|
| Rate for Payer: United Healthcare All Payer |
$986.48
|
|
|
ASPIRATION BREAST
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$672.60 |
| Rate for Payer: Aetna Commercial |
$70.24
|
| Rate for Payer: Ambetter Exchange |
$40.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.35
|
| Rate for Payer: Anthem Medicaid |
$36.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$40.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.38
|
| Rate for Payer: Cash Price |
$560.50
|
| Rate for Payer: Cash Price |
$560.50
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Healthspan PPO |
$125.93
|
| Rate for Payer: Humana Medicaid |
$36.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$40.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.27
|
| Rate for Payer: Molina Healthcare Passport |
$36.54
|
| Rate for Payer: Multiplan PHCS |
$672.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.42
|
| Rate for Payer: UHCCP Medicaid |
$30.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.32
|
|
|
ASPIRATION BREAST(P
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
761P0274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Aetna Commercial |
$70.24
|
| Rate for Payer: Ambetter Exchange |
$40.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.35
|
| Rate for Payer: Anthem Medicaid |
$36.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$40.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.38
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Healthspan PPO |
$125.93
|
| Rate for Payer: Humana Medicaid |
$36.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$40.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.27
|
| Rate for Payer: Molina Healthcare Passport |
$36.54
|
| Rate for Payer: Multiplan PHCS |
$90.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.42
|
| Rate for Payer: UHCCP Medicaid |
$30.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.32
|
|
|
ASPIRATION BREAST(T
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
761T0274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.58 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem Medicaid |
$333.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Humana KY Medicaid |
$333.58
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$336.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$340.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
ASPIRATION BREAST(T
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
761T0274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
ASPIRATION BS NEEDLE W/SHEATH
|
Facility
|
OP
|
$1,901.67
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.50 |
| Max. Negotiated Rate |
$1,825.60 |
| Rate for Payer: Aetna Commercial |
$1,464.29
|
| Rate for Payer: Anthem Medicaid |
$653.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.30
|
| Rate for Payer: Cash Price |
$950.83
|
| Rate for Payer: Cigna Commercial |
$1,578.39
|
| Rate for Payer: First Health Commercial |
$1,806.59
|
| Rate for Payer: Humana Commercial |
$1,616.42
|
| Rate for Payer: Humana KY Medicaid |
$653.98
|
| Rate for Payer: Kentucky WC Medicaid |
$660.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,559.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,403.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$667.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,673.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,426.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,654.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,312.15
|
| Rate for Payer: PHCS Commercial |
$1,825.60
|
| Rate for Payer: United Healthcare All Payer |
$1,673.47
|
|
|
ASPIRATION BS NEEDLE W/SHEATH
|
Facility
|
IP
|
$1,901.67
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$570.50 |
| Max. Negotiated Rate |
$1,825.60 |
| Rate for Payer: Aetna Commercial |
$1,464.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,483.30
|
| Rate for Payer: Cash Price |
$950.83
|
| Rate for Payer: Cigna Commercial |
$1,578.39
|
| Rate for Payer: First Health Commercial |
$1,806.59
|
| Rate for Payer: Humana Commercial |
$1,616.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,559.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,403.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,673.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,426.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,654.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,312.15
|
| Rate for Payer: PHCS Commercial |
$1,825.60
|
| Rate for Payer: United Healthcare All Payer |
$1,673.47
|
|
|
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$2,649.89
|
|
|
Service Code
|
CPT 51102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,892.78 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
|
|
ASPIRE RX MECHANICAL TECH. 6FR
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
ASPIRE RX MECHANICAL TECH. 6FR
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
ASPIRIN 300 MG SUPPO 300MG/1EA
|
Facility
|
IP
|
$9.17
|
|
|
Service Code
|
NDC 574703412
|
| Hospital Charge Code |
25000265
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.15
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.61
|
| Rate for Payer: First Health Commercial |
$8.71
|
| Rate for Payer: Humana Commercial |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.07
|
| Rate for Payer: Ohio Health Group HMO |
$6.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.33
|
| Rate for Payer: PHCS Commercial |
$8.80
|
| Rate for Payer: United Healthcare All Payer |
$8.07
|
|
|
ASPIRIN 300 MG SUPPO 300MG/1EA
|
Facility
|
OP
|
$9.17
|
|
|
Service Code
|
NDC 574703412
|
| Hospital Charge Code |
25000265
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Anthem Medicaid |
$3.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.15
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.61
|
| Rate for Payer: First Health Commercial |
$8.71
|
| Rate for Payer: Humana Commercial |
$7.79
|
| Rate for Payer: Humana KY Medicaid |
$3.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.07
|
| Rate for Payer: Ohio Health Group HMO |
$6.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.33
|
| Rate for Payer: PHCS Commercial |
$8.80
|
| Rate for Payer: United Healthcare All Payer |
$8.07
|
|
|
ASPIRIN (BUFFERED) 325MG/1TAB
|
Facility
|
OP
|
$4.22
|
|
|
Service Code
|
NDC 904201559
|
| Hospital Charge Code |
25000264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ASPIRIN (BUFFERED) 325MG/1TAB
|
Facility
|
IP
|
$4.22
|
|
|
Service Code
|
NDC 904201559
|
| Hospital Charge Code |
25000264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ASPIRIN CHEW TABLET 81MG/1TAB
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 904679480
|
| Hospital Charge Code |
25000267
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
ASPIRIN CHEW TABLET 81MG/1TAB
|
Facility
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 904679480
|
| Hospital Charge Code |
25000267
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
ASPIRIN EC 325 MG T 325MG/1TAB
|
Facility
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 57896092110
|
| Hospital Charge Code |
25000268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
ASPIRIN EC 325 MG T 325MG/1TAB
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 57896092110
|
| Hospital Charge Code |
25000268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
ASPIRIN EC TABLET 81 MG
|
Facility
|
IP
|
$4.22
|
|
|
Service Code
|
NDC 46122061587
|
| Hospital Charge Code |
25000269
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ASPIRIN EC TABLET 81 MG
|
Facility
|
OP
|
$4.22
|
|
|
Service Code
|
NDC 46122061587
|
| Hospital Charge Code |
25000269
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ASPIR OR INJ GANGLION
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
76100347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$496.32 |
| Rate for Payer: Aetna Commercial |
$398.09
|
| Rate for Payer: Anthem Medicaid |
$177.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$403.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cigna Commercial |
$429.11
|
| Rate for Payer: First Health Commercial |
$491.15
|
| Rate for Payer: Humana Commercial |
$439.45
|
| Rate for Payer: Humana KY Medicaid |
$177.80
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$179.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$381.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$181.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.96
|
| Rate for Payer: Ohio Health Group HMO |
$387.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.73
|
| Rate for Payer: PHCS Commercial |
$496.32
|
| Rate for Payer: United Healthcare All Payer |
$454.96
|
|
|
ASPIR OR INJ GANGLION
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
76100347
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$496.32 |
| Rate for Payer: Aetna Commercial |
$398.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$403.26
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cigna Commercial |
$429.11
|
| Rate for Payer: First Health Commercial |
$491.15
|
| Rate for Payer: Humana Commercial |
$439.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$423.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$381.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$454.96
|
| Rate for Payer: Ohio Health Group HMO |
$387.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.73
|
| Rate for Payer: PHCS Commercial |
$496.32
|
| Rate for Payer: United Healthcare All Payer |
$454.96
|
|
