|
ADDERALL 20MG TABLET
|
Facility
|
IP
|
$71.73
|
|
|
Service Code
|
NDC 57844012001
|
| Hospital Charge Code |
25000155
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$68.86 |
| Rate for Payer: Aetna Commercial |
$55.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.95
|
| Rate for Payer: Cash Price |
$35.87
|
| Rate for Payer: Cigna Commercial |
$59.54
|
| Rate for Payer: First Health Commercial |
$68.14
|
| Rate for Payer: Humana Commercial |
$60.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.12
|
| Rate for Payer: Ohio Health Group HMO |
$53.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.49
|
| Rate for Payer: PHCS Commercial |
$68.86
|
| Rate for Payer: United Healthcare All Payer |
$63.12
|
|
|
ADDERALL 20MG TABLET
|
Facility
|
OP
|
$71.73
|
|
|
Service Code
|
NDC 57844012001
|
| Hospital Charge Code |
25000155
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$68.86 |
| Rate for Payer: Aetna Commercial |
$55.23
|
| Rate for Payer: Anthem Medicaid |
$24.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.95
|
| Rate for Payer: Cash Price |
$35.87
|
| Rate for Payer: Cigna Commercial |
$59.54
|
| Rate for Payer: First Health Commercial |
$68.14
|
| Rate for Payer: Humana Commercial |
$60.97
|
| Rate for Payer: Humana KY Medicaid |
$24.67
|
| Rate for Payer: Kentucky WC Medicaid |
$24.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.12
|
| Rate for Payer: Ohio Health Group HMO |
$53.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.49
|
| Rate for Payer: PHCS Commercial |
$68.86
|
| Rate for Payer: United Healthcare All Payer |
$63.12
|
|
|
ADDERALL (AMPH/DEXT) 5 MG
|
Facility
|
IP
|
$60.37
|
|
|
Service Code
|
NDC 13107006801
|
| Hospital Charge Code |
25000156
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.11 |
| 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 |
$48.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.66
|
| Rate for Payer: PHCS Commercial |
$57.96
|
| Rate for Payer: United Healthcare All Payer |
$53.13
|
|
|
ADDERALL (AMPH/DEXT) 5 MG
|
Facility
|
OP
|
$60.37
|
|
|
Service Code
|
NDC 13107006801
|
| Hospital Charge Code |
25000156
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.11 |
| 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 |
$48.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.66
|
| Rate for Payer: PHCS Commercial |
$57.96
|
| Rate for Payer: United Healthcare All Payer |
$53.13
|
|
|
ADDERALL(AMPHET-DEXO) 10MG TAB
|
Facility
|
OP
|
$71.73
|
|
|
Service Code
|
NDC 57844011001
|
| Hospital Charge Code |
25000159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$68.86 |
| Rate for Payer: Aetna Commercial |
$55.23
|
| Rate for Payer: Anthem Medicaid |
$24.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.95
|
| Rate for Payer: Cash Price |
$35.87
|
| Rate for Payer: Cigna Commercial |
$59.54
|
| Rate for Payer: First Health Commercial |
$68.14
|
| Rate for Payer: Humana Commercial |
$60.97
|
| Rate for Payer: Humana KY Medicaid |
$24.67
|
| Rate for Payer: Kentucky WC Medicaid |
$24.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.12
|
| Rate for Payer: Ohio Health Group HMO |
$53.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.49
|
| Rate for Payer: PHCS Commercial |
$68.86
|
| Rate for Payer: United Healthcare All Payer |
$63.12
|
|
|
ADDERALL(AMPHET-DEXO) 10MG TAB
|
Facility
|
IP
|
$71.73
|
|
|
Service Code
|
NDC 57844011001
|
| Hospital Charge Code |
25000159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$68.86 |
| Rate for Payer: Aetna Commercial |
$55.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.95
|
| Rate for Payer: Cash Price |
$35.87
|
| Rate for Payer: Cigna Commercial |
$59.54
|
| Rate for Payer: First Health Commercial |
$68.14
|
| Rate for Payer: Humana Commercial |
$60.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.12
|
| Rate for Payer: Ohio Health Group HMO |
$53.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.49
|
| Rate for Payer: PHCS Commercial |
$68.86
|
| Rate for Payer: United Healthcare All Payer |
$63.12
|
|
|
ADDWIRE EXTENSION WIRE
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
ADDWIRE EXTENSION WIRE
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
ADENOIDECTOMY
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 42831
|
| Hospital Charge Code |
76101711
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.95 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| 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 |
$2,996.53
|
| 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 |
$3,595.84
|
| 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 |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
ADENOIDECTOMY
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 42831
|
| Hospital Charge Code |
76101711
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.00 |
| 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 |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| 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 |
$320.53 |
| Rate for Payer: Aetna Commercial |
$320.53
|
| Rate for Payer: Ambetter Exchange |
$218.59
|
| Rate for Payer: Anthem Medicaid |
$145.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$218.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$218.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.31
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$218.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$218.59
|
| 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 |
$284.17
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$218.59
|
|
|
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 |
$320.53 |
| Rate for Payer: Aetna Commercial |
$320.53
|
| Rate for Payer: Ambetter Exchange |
$218.59
|
| Rate for Payer: Anthem Medicaid |
$145.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$218.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$218.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.31
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$218.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$218.59
|
| 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 |
$284.17
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$147.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$218.59
|
|
|
ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$4,195.14
|
|
|
Service Code
|
CPT 42830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,996.53 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
|
|
ADENOS DIPHOSPHA PLATEL AGGREG
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
30000614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
ADENOS DIPHOSPHA PLATEL AGGREG
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
30000614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$24.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.91
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| 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 |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
ADENOSINE 1MG (60MG SDV)
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
25001828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.50 |
| 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 |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.85
|
| Rate for Payer: PHCS Commercial |
$350.40
|
| Rate for Payer: United Healthcare All Payer |
$321.20
|
|
|
ADENOSINE 1MG (60MG SDV)
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
25001828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.50 |
| 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 |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.85
|
| 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 |
$33.90 |
| 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 |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.97
|
| 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 |
$33.90 |
| 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 |
$90.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.97
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
ADENOSINE FLOWWIRE 1MG(60MGKIT
|
Facility
|
IP
|
$204.73
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
25001830
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.42 |
| Max. Negotiated Rate |
$196.54 |
| Rate for Payer: Aetna Commercial |
$157.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.69
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cigna Commercial |
$169.93
|
| Rate for Payer: First Health Commercial |
$194.49
|
| Rate for Payer: Humana Commercial |
$174.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.16
|
| Rate for Payer: Ohio Health Group HMO |
$153.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.26
|
| Rate for Payer: PHCS Commercial |
$196.54
|
| Rate for Payer: United Healthcare All Payer |
$180.16
|
|
|
ADENOSINE FLOWWIRE 1MG(60MGKIT
|
Facility
|
OP
|
$204.73
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
25001830
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.42 |
| Max. Negotiated Rate |
$196.54 |
| Rate for Payer: Aetna Commercial |
$157.64
|
| Rate for Payer: Anthem Medicaid |
$70.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.69
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cigna Commercial |
$169.93
|
| Rate for Payer: First Health Commercial |
$194.49
|
| Rate for Payer: Humana Commercial |
$174.02
|
| Rate for Payer: Humana KY Medicaid |
$70.41
|
| Rate for Payer: Kentucky WC Medicaid |
$71.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.16
|
| Rate for Payer: Ohio Health Group HMO |
$153.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.26
|
| Rate for Payer: PHCS Commercial |
$196.54
|
| Rate for Payer: United Healthcare All Payer |
$180.16
|
|
|
ADENOSINE INTRACORNAKIT 6MGCCL
|
Facility
|
IP
|
$114.42
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
25001831
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$109.84 |
| Rate for Payer: Aetna Commercial |
$88.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.25
|
| Rate for Payer: Cash Price |
$57.21
|
| Rate for Payer: Cigna Commercial |
$94.97
|
| Rate for Payer: First Health Commercial |
$108.70
|
| Rate for Payer: Humana Commercial |
$97.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.69
|
| Rate for Payer: Ohio Health Group HMO |
$85.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.95
|
| Rate for Payer: PHCS Commercial |
$109.84
|
| Rate for Payer: United Healthcare All Payer |
$100.69
|
|
|
ADENOSINE INTRACORNAKIT 6MGCCL
|
Facility
|
OP
|
$114.42
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
25001831
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$109.84 |
| Rate for Payer: Aetna Commercial |
$88.10
|
| Rate for Payer: Anthem Medicaid |
$39.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.25
|
| Rate for Payer: Cash Price |
$57.21
|
| Rate for Payer: Cigna Commercial |
$94.97
|
| Rate for Payer: First Health Commercial |
$108.70
|
| Rate for Payer: Humana Commercial |
$97.26
|
| Rate for Payer: Humana KY Medicaid |
$39.35
|
| Rate for Payer: Kentucky WC Medicaid |
$39.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.69
|
| Rate for Payer: Ohio Health Group HMO |
$85.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.95
|
| Rate for Payer: PHCS Commercial |
$109.84
|
| Rate for Payer: United Healthcare All Payer |
$100.69
|
|
|
ADJACENT TISSUE 10SQ CM OR LES
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 14020
|
| Hospital Charge Code |
761P0164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.02 |
| Max. Negotiated Rate |
$938.23 |
| Rate for Payer: Aetna Commercial |
$807.28
|
| Rate for Payer: Ambetter Exchange |
$531.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$286.02
|
| Rate for Payer: Anthem Medicaid |
$321.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$531.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$531.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$638.39
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$938.23
|
| Rate for Payer: Healthspan PPO |
$765.32
|
| Rate for Payer: Humana Medicaid |
$321.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$715.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$531.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.17
|
| Rate for Payer: Molina Healthcare Passport |
$321.74
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$691.59
|
| Rate for Payer: UHCCP Medicaid |
$300.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$324.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$531.99
|
|
|
ADJACENT TISSUE 10SQ CM OR LES
|
Professional
|
Both
|
$6,209.00
|
|
|
Service Code
|
HCPCS 14020
|
| Hospital Charge Code |
76100164
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.02 |
| Max. Negotiated Rate |
$3,725.40 |
| Rate for Payer: Aetna Commercial |
$807.28
|
| Rate for Payer: Ambetter Exchange |
$531.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$286.02
|
| Rate for Payer: Anthem Medicaid |
$321.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$531.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$531.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$638.39
|
| Rate for Payer: Cash Price |
$3,104.50
|
| Rate for Payer: Cash Price |
$3,104.50
|
| Rate for Payer: Cigna Commercial |
$938.23
|
| Rate for Payer: Healthspan PPO |
$765.32
|
| Rate for Payer: Humana Medicaid |
$321.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$715.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$531.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.17
|
| Rate for Payer: Molina Healthcare Passport |
$321.74
|
| Rate for Payer: Multiplan PHCS |
$3,725.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$691.59
|
| Rate for Payer: UHCCP Medicaid |
$300.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$324.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$531.99
|
|
