|
ADAPTOR NON-LOCKING
|
Facility
|
IP
|
$1,825.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.35 |
| Max. Negotiated Rate |
$1,752.73 |
| Rate for Payer: Aetna Commercial |
$1,405.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,424.09
|
| Rate for Payer: Cash Price |
$912.88
|
| Rate for Payer: Cigna Commercial |
$1,515.38
|
| Rate for Payer: First Health Commercial |
$1,734.47
|
| Rate for Payer: Humana Commercial |
$1,551.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,497.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,347.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,369.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.99
|
| Rate for Payer: PHCS Commercial |
$1,752.73
|
| Rate for Payer: United Healthcare All Payer |
$1,606.67
|
|
|
ADAPTOR NON-LOCKING
|
Facility
|
OP
|
$1,825.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.35 |
| Max. Negotiated Rate |
$1,752.73 |
| Rate for Payer: Aetna Commercial |
$1,405.84
|
| Rate for Payer: Anthem Medicaid |
$627.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,424.09
|
| Rate for Payer: Cash Price |
$912.88
|
| Rate for Payer: Cigna Commercial |
$1,515.38
|
| Rate for Payer: First Health Commercial |
$1,734.47
|
| Rate for Payer: Humana Commercial |
$1,551.90
|
| Rate for Payer: Humana KY Medicaid |
$627.88
|
| Rate for Payer: Kentucky WC Medicaid |
$634.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,497.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,347.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,369.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.99
|
| Rate for Payer: PHCS Commercial |
$1,752.73
|
| Rate for Payer: United Healthcare All Payer |
$1,606.67
|
|
|
ADAPTOR PIGTAIL G05297
|
Facility
|
IP
|
$1,535.46
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.61 |
| Max. Negotiated Rate |
$1,474.04 |
| Rate for Payer: Aetna Commercial |
$1,182.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,197.66
|
| Rate for Payer: Cash Price |
$767.73
|
| Rate for Payer: Cigna Commercial |
$1,274.43
|
| Rate for Payer: First Health Commercial |
$1,458.69
|
| Rate for Payer: Humana Commercial |
$1,305.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,259.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,133.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,351.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,151.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$475.99
|
| Rate for Payer: PHCS Commercial |
$1,474.04
|
| Rate for Payer: United Healthcare All Payer |
$1,351.20
|
|
|
ADAPTOR PIGTAIL G05297
|
Facility
|
OP
|
$1,535.46
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.61 |
| Max. Negotiated Rate |
$1,474.04 |
| Rate for Payer: Aetna Commercial |
$1,182.30
|
| Rate for Payer: Anthem Medicaid |
$528.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,197.66
|
| Rate for Payer: Cash Price |
$767.73
|
| Rate for Payer: Cigna Commercial |
$1,274.43
|
| Rate for Payer: First Health Commercial |
$1,458.69
|
| Rate for Payer: Humana Commercial |
$1,305.14
|
| Rate for Payer: Humana KY Medicaid |
$528.04
|
| Rate for Payer: Kentucky WC Medicaid |
$533.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,259.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,133.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$538.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,351.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,151.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$475.99
|
| Rate for Payer: PHCS Commercial |
$1,474.04
|
| Rate for Payer: United Healthcare All Payer |
$1,351.20
|
|
|
ADCETRIS 50 MG/10 ML VIAL
|
Facility
|
OP
|
$63,993.90
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
25004006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.61 |
| Max. Negotiated Rate |
$61,434.14 |
| Rate for Payer: Aetna Commercial |
$49,275.30
|
| Rate for Payer: Anthem Medicaid |
$22,007.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$230.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49,915.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$322.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$311.33
|
| Rate for Payer: Cash Price |
$31,996.95
|
| Rate for Payer: Cash Price |
$31,996.95
|
| Rate for Payer: Cigna Commercial |
$53,114.94
|
| Rate for Payer: First Health Commercial |
$60,794.20
|
| Rate for Payer: Humana Commercial |
$54,394.82
|
| Rate for Payer: Humana KY Medicaid |
$22,007.50
|
| Rate for Payer: Humana Medicare Advantage |
$230.61
|
| Rate for Payer: Kentucky WC Medicaid |
$22,231.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47,227.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,449.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$56,314.63
|
| Rate for Payer: Ohio Health Group HMO |
$47,995.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,798.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,319.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,838.11
|
| Rate for Payer: PHCS Commercial |
$61,434.14
|
| Rate for Payer: United Healthcare All Payer |
$56,314.63
|
|
|
ADCETRIS 50 MG/10 ML VIAL
|
Facility
|
IP
|
$63,993.90
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
25004006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,319.21 |
| Max. Negotiated Rate |
$61,434.14 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52,475.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47,227.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,198.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$56,314.63
|
| Rate for Payer: Ohio Health Group HMO |
$47,995.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,798.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,319.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,838.11
|
| Rate for Payer: PHCS Commercial |
$61,434.14
|
| Rate for Payer: United Healthcare All Payer |
$56,314.63
|
| Rate for Payer: Aetna Commercial |
$49,275.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49,915.24
|
| Rate for Payer: Cash Price |
$31,996.95
|
| Rate for Payer: Cigna Commercial |
$53,114.94
|
| Rate for Payer: First Health Commercial |
$60,794.20
|
| Rate for Payer: Humana Commercial |
$54,394.82
|
|
|
ADDERALL 20MG TABLET
|
Facility
|
IP
|
$70.72
|
|
|
Service Code
|
NDC 57844012001
|
| Hospital Charge Code |
25000155
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$67.89 |
| Rate for Payer: Aetna Commercial |
$54.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.16
|
| Rate for Payer: Cash Price |
$35.36
|
| Rate for Payer: Cigna Commercial |
$58.70
|
| Rate for Payer: First Health Commercial |
$67.18
|
| Rate for Payer: Humana Commercial |
$60.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.23
|
| Rate for Payer: Ohio Health Group HMO |
$53.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.92
|
| Rate for Payer: PHCS Commercial |
$67.89
|
| Rate for Payer: United Healthcare All Payer |
$62.23
|
|
|
ADDERALL 20MG TABLET
|
Facility
|
OP
|
$70.72
|
|
|
Service Code
|
NDC 57844012001
|
| Hospital Charge Code |
25000155
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$67.89 |
| Rate for Payer: Aetna Commercial |
$54.45
|
| Rate for Payer: Anthem Medicaid |
$24.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.16
|
| Rate for Payer: Cash Price |
$35.36
|
| Rate for Payer: Cigna Commercial |
$58.70
|
| Rate for Payer: First Health Commercial |
$67.18
|
| Rate for Payer: Humana Commercial |
$60.11
|
| Rate for Payer: Humana KY Medicaid |
$24.32
|
| Rate for Payer: Kentucky WC Medicaid |
$24.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.23
|
| Rate for Payer: Ohio Health Group HMO |
$53.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.92
|
| Rate for Payer: PHCS Commercial |
$67.89
|
| Rate for Payer: United Healthcare All Payer |
$62.23
|
|
|
ADDERALL (AMPH/DEXT) 5 MG
|
Facility
|
OP
|
$60.37
|
|
|
Service Code
|
NDC 13107006801
|
| Hospital Charge Code |
25000156
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$46.48
|
| Rate for Payer: Anthem Medicaid |
$20.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.09
|
| Rate for Payer: Cash Price |
$30.18
|
| Rate for Payer: Cigna Commercial |
$50.11
|
| Rate for Payer: First Health Commercial |
$57.35
|
| Rate for Payer: Humana Commercial |
$51.31
|
| Rate for Payer: Humana KY Medicaid |
$20.76
|
| Rate for Payer: Kentucky WC Medicaid |
$20.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.13
|
| Rate for Payer: Ohio Health Group HMO |
$45.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.71
|
| Rate for Payer: PHCS Commercial |
$57.96
|
| Rate for Payer: United Healthcare All Payer |
$53.13
|
|
|
ADDERALL (AMPH/DEXT) 5 MG
|
Facility
|
IP
|
$60.37
|
|
|
Service Code
|
NDC 13107006801
|
| Hospital Charge Code |
25000156
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$46.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.09
|
| Rate for Payer: Cash Price |
$30.18
|
| Rate for Payer: Cigna Commercial |
$50.11
|
| Rate for Payer: First Health Commercial |
$57.35
|
| Rate for Payer: Humana Commercial |
$51.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.13
|
| Rate for Payer: Ohio Health Group HMO |
$45.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.71
|
| Rate for Payer: PHCS Commercial |
$57.96
|
| Rate for Payer: United Healthcare All Payer |
$53.13
|
|
|
ADDERALL(AMPHET-DEXO) 10MG TAB
|
Facility
|
OP
|
$70.72
|
|
|
Service Code
|
NDC 57844011001
|
| Hospital Charge Code |
25000159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$67.89 |
| Rate for Payer: Aetna Commercial |
$54.45
|
| Rate for Payer: Anthem Medicaid |
$24.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.16
|
| Rate for Payer: Cash Price |
$35.36
|
| Rate for Payer: Cigna Commercial |
$58.70
|
| Rate for Payer: First Health Commercial |
$67.18
|
| Rate for Payer: Humana Commercial |
$60.11
|
| Rate for Payer: Humana KY Medicaid |
$24.32
|
| Rate for Payer: Kentucky WC Medicaid |
$24.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.23
|
| Rate for Payer: Ohio Health Group HMO |
$53.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.92
|
| Rate for Payer: PHCS Commercial |
$67.89
|
| Rate for Payer: United Healthcare All Payer |
$62.23
|
|
|
ADDERALL(AMPHET-DEXO) 10MG TAB
|
Facility
|
IP
|
$70.72
|
|
|
Service Code
|
NDC 57844011001
|
| Hospital Charge Code |
25000159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$67.89 |
| Rate for Payer: Aetna Commercial |
$54.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.16
|
| Rate for Payer: Cash Price |
$35.36
|
| Rate for Payer: Cigna Commercial |
$58.70
|
| Rate for Payer: First Health Commercial |
$67.18
|
| Rate for Payer: Humana Commercial |
$60.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.23
|
| Rate for Payer: Ohio Health Group HMO |
$53.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.92
|
| Rate for Payer: PHCS Commercial |
$67.89
|
| Rate for Payer: United Healthcare All Payer |
$62.23
|
|
|
ADDWIRE EXTENSION WIRE
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
ADDWIRE EXTENSION WIRE
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
ADENOIDECTOMY
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 42831
|
| Hospital Charge Code |
76101711
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
ADENOIDECTOMY
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 42831
|
| Hospital Charge Code |
76101711
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
ADENOIDECTOMY
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 42831
|
| Hospital Charge Code |
76101711
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.96 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$320.53
|
| Rate for Payer: Anthem Medicaid |
$145.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$317.45
|
| Rate for Payer: Healthspan PPO |
$270.31
|
| Rate for Payer: Humana Medicaid |
$145.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$287.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.88
|
| Rate for Payer: Molina Healthcare Passport |
$145.96
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.42
|
|
|
ADENOIDECTOMY(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 42831
|
| Hospital Charge Code |
761P1711
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.96 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$320.53
|
| Rate for Payer: Anthem Medicaid |
$145.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$317.45
|
| Rate for Payer: Healthspan PPO |
$270.31
|
| Rate for Payer: Humana Medicaid |
$145.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$287.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.88
|
| Rate for Payer: Molina Healthcare Passport |
$145.96
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.42
|
|
|
ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$3,897.84
|
|
|
Service Code
|
CPT 42830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,784.17 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
|
|
ADENOS DIPHOSPHA PLATEL AGGREG
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
30000614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem Medicaid |
$24.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.91
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Humana KY Medicaid |
$24.91
|
| Rate for Payer: Humana Medicare Advantage |
$24.91
|
| Rate for Payer: Kentucky WC Medicaid |
$25.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
ADENOS DIPHOSPHA PLATEL AGGREG
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
30000614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
ADENOSINE 1MG (60MG SDV)
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
25001828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$350.40 |
| Rate for Payer: Aetna Commercial |
$281.05
|
| Rate for Payer: Anthem Medicaid |
$125.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.70
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$302.95
|
| Rate for Payer: First Health Commercial |
$346.75
|
| Rate for Payer: Humana Commercial |
$310.25
|
| Rate for Payer: Humana KY Medicaid |
$125.52
|
| Rate for Payer: Kentucky WC Medicaid |
$126.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$299.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$269.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$321.20
|
| Rate for Payer: Ohio Health Group HMO |
$273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.15
|
| Rate for Payer: PHCS Commercial |
$350.40
|
| Rate for Payer: United Healthcare All Payer |
$321.20
|
|
|
ADENOSINE 1MG (60MG SDV)
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
25001828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$350.40 |
| Rate for Payer: Aetna Commercial |
$281.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.70
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$302.95
|
| Rate for Payer: First Health Commercial |
$346.75
|
| Rate for Payer: Humana Commercial |
$310.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$299.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$269.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$321.20
|
| Rate for Payer: Ohio Health Group HMO |
$273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.15
|
| Rate for Payer: PHCS Commercial |
$350.40
|
| Rate for Payer: United Healthcare All Payer |
$321.20
|
|
|
ADENOSINE 1MG [6MG/2ML VIAL]
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
25001827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$38.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$38.86
|
| Rate for Payer: Kentucky WC Medicaid |
$39.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
ADENOSINE 1MG [6MG/2ML VIAL]
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
25001827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
