|
ATROVENT (IPRATOPIUM) 15ML
|
Facility
|
IP
|
$1.14
|
|
|
Service Code
|
NDC 24208039915
|
| Hospital Charge Code |
25000280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.89
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna Commercial |
$0.95
|
| Rate for Payer: First Health Commercial |
$1.08
|
| Rate for Payer: Humana Commercial |
$0.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.00
|
| Rate for Payer: Ohio Health Group HMO |
$0.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.79
|
| Rate for Payer: PHCS Commercial |
$1.09
|
| Rate for Payer: United Healthcare All Payer |
$1.00
|
|
|
ATROVENT(IPRATR)HFAINH12.90GM
|
Facility
|
IP
|
$911.84
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25000282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.55 |
| Max. Negotiated Rate |
$875.37 |
| Rate for Payer: Aetna Commercial |
$702.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$711.24
|
| Rate for Payer: Cash Price |
$455.92
|
| Rate for Payer: Cigna Commercial |
$756.83
|
| Rate for Payer: First Health Commercial |
$866.25
|
| Rate for Payer: Humana Commercial |
$775.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$802.42
|
| Rate for Payer: Ohio Health Group HMO |
$683.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$729.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$793.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.17
|
| Rate for Payer: PHCS Commercial |
$875.37
|
| Rate for Payer: United Healthcare All Payer |
$802.42
|
|
|
ATROVENT(IPRATR)HFAINH12.90GM
|
Facility
|
OP
|
$911.84
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25000282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.55 |
| Max. Negotiated Rate |
$875.37 |
| Rate for Payer: Aetna Commercial |
$702.12
|
| Rate for Payer: Anthem Medicaid |
$313.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$711.24
|
| Rate for Payer: Cash Price |
$455.92
|
| Rate for Payer: Cigna Commercial |
$756.83
|
| Rate for Payer: First Health Commercial |
$866.25
|
| Rate for Payer: Humana Commercial |
$775.06
|
| Rate for Payer: Humana KY Medicaid |
$313.58
|
| Rate for Payer: Kentucky WC Medicaid |
$316.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$802.42
|
| Rate for Payer: Ohio Health Group HMO |
$683.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$729.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$793.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.17
|
| Rate for Payer: PHCS Commercial |
$875.37
|
| Rate for Payer: United Healthcare All Payer |
$802.42
|
|
|
ATROVENT (IPRATROPIUM) 2.5ML
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 60687039479
|
| Hospital Charge Code |
25000281
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
ATROVENT (IPRATROPIUM) 2.5ML
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 60687039479
|
| Hospital Charge Code |
25000281
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.96
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.32
|
| Rate for Payer: United Healthcare All Payer |
$3.96
|
|
|
ATROVENT (IPROTROPIUM) NA 30ML
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 54004544
|
| Hospital Charge Code |
25000283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna Commercial |
$0.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.42
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna Commercial |
$0.45
|
| Rate for Payer: First Health Commercial |
$0.51
|
| Rate for Payer: Humana Commercial |
$0.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.48
|
| Rate for Payer: Ohio Health Group HMO |
$0.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.37
|
| Rate for Payer: PHCS Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Payer |
$0.48
|
|
|
ATROVENT (IPROTROPIUM) NA 30ML
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 54004544
|
| Hospital Charge Code |
25000283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Aetna Commercial |
$0.42
|
| Rate for Payer: Anthem Medicaid |
$0.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.42
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna Commercial |
$0.45
|
| Rate for Payer: First Health Commercial |
$0.51
|
| Rate for Payer: Humana Commercial |
$0.46
|
| Rate for Payer: Humana KY Medicaid |
$0.19
|
| Rate for Payer: Kentucky WC Medicaid |
$0.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.48
|
| Rate for Payer: Ohio Health Group HMO |
$0.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.37
|
| Rate for Payer: PHCS Commercial |
$0.52
|
| Rate for Payer: United Healthcare All Payer |
$0.48
|
|
|
ATTAIN COMMAND CATH 6250V-45S
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,886.40 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Anthem Medicaid |
$675.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Humana KY Medicaid |
$675.76
|
| Rate for Payer: Kentucky WC Medicaid |
$682.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.85
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
|
ATTAIN COMMAND CATH 6250V-45S
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,886.40 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.85
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
|
ATTAIN COMMAND CATH 6250V-50S
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,886.40 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.85
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
|
ATTAIN COMMAND CATH 6250V-50S
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,886.40 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Anthem Medicaid |
$675.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Humana KY Medicaid |
$675.76
|
| Rate for Payer: Kentucky WC Medicaid |
$682.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.85
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
|
ATTAIN COMMAND CATH 6250V-EH
|
Facility
|
IP
|
$2,105.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
ATTAIN COMMAND CATH 6250V-EH
|
Facility
|
OP
|
$2,105.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem Medicaid |
$724.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Humana KY Medicaid |
$724.12
|
| Rate for Payer: Kentucky WC Medicaid |
$731.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
ATTENDANCE AT DELIVERY
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 99464
|
| Hospital Charge Code |
51000120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$313.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.40
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
ATTENDANCE AT DELIVERY
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 99464
|
| Hospital Charge Code |
51000120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.26 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$112.28
|
| Rate for Payer: Ambetter Exchange |
$67.77
|
| Rate for Payer: Anthem Medicaid |
$57.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$67.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$67.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$81.32
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$114.01
|
| Rate for Payer: Healthspan PPO |
$83.47
|
| Rate for Payer: Humana Medicaid |
$57.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$67.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.41
|
| Rate for Payer: Molina Healthcare Passport |
$57.26
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$88.10
|
| Rate for Payer: UHCCP Medicaid |
$126.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$67.77
|
|
|
ATTENDANCE AT DELIVERY
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 99464
|
| Hospital Charge Code |
51000120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem Medicaid |
$123.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Humana KY Medicaid |
$123.80
|
| Rate for Payer: Kentucky WC Medicaid |
$125.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$313.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.40
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
ATTENDANCE AT DELIVERY(P
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 99464
|
| Hospital Charge Code |
510P0120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.26 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$112.28
|
| Rate for Payer: Ambetter Exchange |
$67.77
|
| Rate for Payer: Anthem Medicaid |
$57.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$67.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$67.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$81.32
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$114.01
|
| Rate for Payer: Healthspan PPO |
$83.47
|
| Rate for Payer: Humana Medicaid |
$57.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$97.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$67.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.41
|
| Rate for Payer: Molina Healthcare Passport |
$57.26
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$88.10
|
| Rate for Payer: UHCCP Medicaid |
$126.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$67.77
|
|
|
AUDIT/DAST 15-30 MIN
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 99408
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.98 |
| Max. Negotiated Rate |
$103.60 |
| Rate for Payer: Aetna Commercial |
$50.01
|
| Rate for Payer: Anthem Medicaid |
$20.98
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$44.70
|
| Rate for Payer: Healthspan PPO |
$40.73
|
| Rate for Payer: Humana Medicaid |
$20.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.40
|
| Rate for Payer: Molina Healthcare Passport |
$20.98
|
| Rate for Payer: Multiplan PHCS |
$88.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$103.60
|
| Rate for Payer: UHCCP Medicaid |
$51.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.19
|
|
|
AUDIT/DAST 15-30 MIN
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 99408
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$142.08 |
| Rate for Payer: Aetna Commercial |
$113.96
|
| Rate for Payer: Anthem Medicaid |
$50.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.44
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$122.84
|
| Rate for Payer: First Health Commercial |
$140.60
|
| Rate for Payer: Humana Commercial |
$125.80
|
| Rate for Payer: Humana KY Medicaid |
$50.90
|
| Rate for Payer: Kentucky WC Medicaid |
$51.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.24
|
| Rate for Payer: Ohio Health Group HMO |
$111.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.12
|
| Rate for Payer: PHCS Commercial |
$142.08
|
| Rate for Payer: United Healthcare All Payer |
$130.24
|
|
|
AUDIT/DAST 15-30 MIN
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 99408
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$142.08 |
| Rate for Payer: Aetna Commercial |
$113.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.44
|
| Rate for Payer: Cash Price |
$74.00
|
| Rate for Payer: Cigna Commercial |
$122.84
|
| Rate for Payer: First Health Commercial |
$140.60
|
| Rate for Payer: Humana Commercial |
$125.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.24
|
| Rate for Payer: Ohio Health Group HMO |
$111.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.12
|
| Rate for Payer: PHCS Commercial |
$142.08
|
| Rate for Payer: United Healthcare All Payer |
$130.24
|
|
|
AUDIT/DAST 15-30 MIN(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99408
|
| Hospital Charge Code |
510P0110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.98 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$50.01
|
| Rate for Payer: Anthem Medicaid |
$20.98
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$44.70
|
| Rate for Payer: Healthspan PPO |
$40.73
|
| Rate for Payer: Humana Medicaid |
$20.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.40
|
| Rate for Payer: Molina Healthcare Passport |
$20.98
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.19
|
|
|
AUDIT/DAST 15-30 MIN(T
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 99408
|
| Hospital Charge Code |
510T0110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.44
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
AUDIT/DAST 15-30 MIN(T
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 99408
|
| Hospital Charge Code |
510T0110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$16.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.44
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Humana KY Medicaid |
$16.51
|
| Rate for Payer: Kentucky WC Medicaid |
$16.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
AUDIT/DAST OVER 30 MIN
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 99409
|
| Hospital Charge Code |
51000111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
AUDIT/DAST OVER 30 MIN
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 99409
|
| Hospital Charge Code |
51000111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$100.74
|
| Rate for Payer: Anthem Medicaid |
$53.20
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$87.77
|
| Rate for Payer: Healthspan PPO |
$80.34
|
| Rate for Payer: Humana Medicaid |
$53.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.26
|
| Rate for Payer: Molina Healthcare Passport |
$53.20
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.00
|
| Rate for Payer: UHCCP Medicaid |
$56.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.73
|
|
