|
ADM OF SOC DTR ASSESS 5-15M
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS G0136
|
| Hospital Charge Code |
51000352
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem Medicaid |
$17.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.49
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Humana KY Medicaid |
$17.20
|
| Rate for Payer: Humana Medicare Advantage |
$24.81
|
| Rate for Payer: Kentucky WC Medicaid |
$17.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
ADM OF SOC DTR ASSESS 5-15M
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS G0136
|
| Hospital Charge Code |
51000352
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
|
|
ADM OF SOC DTR ASSESS 5-15M
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS G0136
|
| Hospital Charge Code |
51000352
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
A + D ORIGINAL OINTMENT(42.5GM
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 41100081163
|
| Hospital Charge Code |
25003730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem Medicaid |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.06
|
| Rate for Payer: First Health Commercial |
$0.07
|
| Rate for Payer: Humana Commercial |
$0.06
|
| Rate for Payer: Humana KY Medicaid |
$0.02
|
| Rate for Payer: Kentucky WC Medicaid |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.06
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Payer |
$0.06
|
|
|
A + D ORIGINAL OINTMENT(42.5GM
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 41100081163
|
| Hospital Charge Code |
25003730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna Commercial |
$0.06
|
| Rate for Payer: First Health Commercial |
$0.07
|
| Rate for Payer: Humana Commercial |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.06
|
| Rate for Payer: Ohio Health Group HMO |
$0.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Payer |
$0.06
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$26,349.05
|
|
|
Service Code
|
MSDRG 614
|
| Min. Negotiated Rate |
$17,879.71 |
| Max. Negotiated Rate |
$26,349.05 |
| Rate for Payer: Anthem Medicaid |
$17,879.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,820.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26,349.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$25,408.01
|
| Rate for Payer: Humana KY Medicaid |
$17,879.71
|
| Rate for Payer: Humana Medicare Advantage |
$18,820.75
|
| Rate for Payer: Kentucky WC Medicaid |
$18,058.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,584.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,237.31
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$17,209.22
|
|
|
Service Code
|
MSDRG 615
|
| Min. Negotiated Rate |
$11,677.68 |
| Max. Negotiated Rate |
$17,209.22 |
| Rate for Payer: Anthem Medicaid |
$11,677.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,292.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,209.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,594.60
|
| Rate for Payer: Humana KY Medicaid |
$11,677.68
|
| Rate for Payer: Humana Medicare Advantage |
$12,292.30
|
| Rate for Payer: Kentucky WC Medicaid |
$11,794.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,750.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,911.24
|
|
|
ADRENALECTOMY PART OR COMPLETE
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 60540
|
| Hospital Charge Code |
761P2281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$835.03 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,606.50
|
| Rate for Payer: Anthem Medicaid |
$835.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,475.99
|
| Rate for Payer: Healthspan PPO |
$1,354.79
|
| Rate for Payer: Humana Medicaid |
$835.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,369.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$851.73
|
| Rate for Payer: Molina Healthcare Passport |
$835.03
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$843.38
|
|
|
ADRENALECTOMY PART OR COMPLETE
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 60540
|
| Hospital Charge Code |
76102281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
ADRENALECTOMY PART OR COMPLETE
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 60540
|
| Hospital Charge Code |
76102281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$835.03 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,606.50
|
| Rate for Payer: Anthem Medicaid |
$835.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,475.99
|
| Rate for Payer: Healthspan PPO |
$1,354.79
|
| Rate for Payer: Humana Medicaid |
$835.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,369.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$851.73
|
| Rate for Payer: Molina Healthcare Passport |
$835.03
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$843.38
|
|
|
ADRENALECTOMY PART OR COMPLETE
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 60540
|
| Hospital Charge Code |
76102281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
ADRENALIN CHLORIDE 0.1MG
|
Facility
|
IP
|
$830.57
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
25001833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.97 |
| Max. Negotiated Rate |
$797.35 |
| Rate for Payer: Aetna Commercial |
$639.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$647.84
|
| Rate for Payer: Cash Price |
$415.29
|
| Rate for Payer: Cigna Commercial |
$689.37
|
| Rate for Payer: First Health Commercial |
$789.04
|
| Rate for Payer: Humana Commercial |
$705.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$681.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$612.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$730.90
|
| Rate for Payer: Ohio Health Group HMO |
$622.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.48
|
| Rate for Payer: PHCS Commercial |
$797.35
|
| Rate for Payer: United Healthcare All Payer |
$730.90
|
|
|
ADRENALIN CHLORIDE 0.1MG
|
Facility
|
OP
|
$830.57
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
25001833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.97 |
| Max. Negotiated Rate |
$797.35 |
| Rate for Payer: Aetna Commercial |
$639.54
|
| Rate for Payer: Anthem Medicaid |
$285.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$647.84
|
| Rate for Payer: Cash Price |
$415.29
|
| Rate for Payer: Cigna Commercial |
$689.37
|
| Rate for Payer: First Health Commercial |
$789.04
|
| Rate for Payer: Humana Commercial |
$705.98
|
| Rate for Payer: Humana KY Medicaid |
$285.63
|
| Rate for Payer: Kentucky WC Medicaid |
$288.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$681.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$612.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$291.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$730.90
|
| Rate for Payer: Ohio Health Group HMO |
$622.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.48
|
| Rate for Payer: PHCS Commercial |
$797.35
|
| Rate for Payer: United Healthcare All Payer |
$730.90
|
|
|
ADRENALIN(EPI)1/1000NASSOL30ML
|
Facility
|
IP
|
$28.52
|
|
|
Service Code
|
NDC 42023010301
|
| Hospital Charge Code |
25002807
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$27.38 |
| Rate for Payer: Aetna Commercial |
$21.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.25
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cigna Commercial |
$23.67
|
| Rate for Payer: First Health Commercial |
$27.09
|
| Rate for Payer: Humana Commercial |
$24.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.10
|
| Rate for Payer: Ohio Health Group HMO |
$21.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.84
|
| Rate for Payer: PHCS Commercial |
$27.38
|
| Rate for Payer: United Healthcare All Payer |
$25.10
|
|
|
ADRENALIN(EPI)1/1000NASSOL30ML
|
Facility
|
OP
|
$28.52
|
|
|
Service Code
|
NDC 42023010301
|
| Hospital Charge Code |
25002807
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$27.38 |
| Rate for Payer: Aetna Commercial |
$21.96
|
| Rate for Payer: Anthem Medicaid |
$9.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.25
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cigna Commercial |
$23.67
|
| Rate for Payer: First Health Commercial |
$27.09
|
| Rate for Payer: Humana Commercial |
$24.24
|
| Rate for Payer: Humana KY Medicaid |
$9.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.10
|
| Rate for Payer: Ohio Health Group HMO |
$21.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.84
|
| Rate for Payer: PHCS Commercial |
$27.38
|
| Rate for Payer: United Healthcare All Payer |
$25.10
|
|
|
ADRENALS US LTD
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,104.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$662.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$772.80
|
| Rate for Payer: UHCCP Medicaid |
$386.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
|
|
ADRENALS US LTD
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$850.08
|
| Rate for Payer: Anthem Medicaid |
$379.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$916.32
|
| Rate for Payer: First Health Commercial |
$1,048.80
|
| Rate for Payer: Humana Commercial |
$938.40
|
| Rate for Payer: Humana KY Medicaid |
$379.67
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$383.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$971.52
|
| Rate for Payer: Ohio Health Group HMO |
$828.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$1,059.84
|
| Rate for Payer: United Healthcare All Payer |
$971.52
|
|
|
ADRENALS US LTD
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$143.52 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$850.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.12
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$916.32
|
| Rate for Payer: First Health Commercial |
$1,048.80
|
| Rate for Payer: Humana Commercial |
$938.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$971.52
|
| Rate for Payer: Ohio Health Group HMO |
$828.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$1,059.84
|
| Rate for Payer: United Healthcare All Payer |
$971.52
|
|
|
ADRENALS US LTD(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402P0015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$157.49 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
|
|
ADRENALS US LTD(T
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.27 |
| Max. Negotiated Rate |
$939.84 |
| Rate for Payer: Aetna Commercial |
$753.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$763.62
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cigna Commercial |
$812.57
|
| Rate for Payer: First Health Commercial |
$930.05
|
| Rate for Payer: Humana Commercial |
$832.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$802.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$722.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$861.52
|
| Rate for Payer: Ohio Health Group HMO |
$734.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.49
|
| Rate for Payer: PHCS Commercial |
$939.84
|
| Rate for Payer: United Healthcare All Payer |
$861.52
|
|
|
ADRENALS US LTD(T
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$939.84 |
| Rate for Payer: Aetna Commercial |
$753.83
|
| Rate for Payer: Anthem Medicaid |
$336.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$763.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cigna Commercial |
$812.57
|
| Rate for Payer: First Health Commercial |
$930.05
|
| Rate for Payer: Humana Commercial |
$832.15
|
| Rate for Payer: Humana KY Medicaid |
$336.68
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$340.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$802.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$722.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$861.52
|
| Rate for Payer: Ohio Health Group HMO |
$734.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.49
|
| Rate for Payer: PHCS Commercial |
$939.84
|
| Rate for Payer: United Healthcare All Payer |
$861.52
|
|
|
ADRIAMYCIN 10MG (50MG VL)
|
Facility
|
OP
|
$133.91
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
25002557
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.41 |
| Max. Negotiated Rate |
$128.55 |
| Rate for Payer: Aetna Commercial |
$103.11
|
| Rate for Payer: Anthem Medicaid |
$46.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.45
|
| Rate for Payer: Cash Price |
$66.96
|
| Rate for Payer: Cigna Commercial |
$111.15
|
| Rate for Payer: First Health Commercial |
$127.21
|
| Rate for Payer: Humana Commercial |
$113.82
|
| Rate for Payer: Humana KY Medicaid |
$46.05
|
| Rate for Payer: Kentucky WC Medicaid |
$46.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.84
|
| Rate for Payer: Ohio Health Group HMO |
$100.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.51
|
| Rate for Payer: PHCS Commercial |
$128.55
|
| Rate for Payer: United Healthcare All Payer |
$117.84
|
|
|
ADRIAMYCIN 10MG (50MG VL)
|
Facility
|
IP
|
$133.91
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
25002557
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.41 |
| Max. Negotiated Rate |
$128.55 |
| Rate for Payer: Aetna Commercial |
$103.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$104.45
|
| Rate for Payer: Cash Price |
$66.96
|
| Rate for Payer: Cigna Commercial |
$111.15
|
| Rate for Payer: First Health Commercial |
$127.21
|
| Rate for Payer: Humana Commercial |
$113.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$109.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$98.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$117.84
|
| Rate for Payer: Ohio Health Group HMO |
$100.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.51
|
| Rate for Payer: PHCS Commercial |
$128.55
|
| Rate for Payer: United Healthcare All Payer |
$117.84
|
|
|
ADRIAMYCIN 10MG/5MLVIAL
|
Facility
|
OP
|
$55.32
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
25002717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$53.11 |
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: Anthem Medicaid |
$19.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.15
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cigna Commercial |
$45.92
|
| Rate for Payer: First Health Commercial |
$52.55
|
| Rate for Payer: Humana Commercial |
$47.02
|
| Rate for Payer: Humana KY Medicaid |
$19.02
|
| Rate for Payer: Kentucky WC Medicaid |
$19.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.68
|
| Rate for Payer: Ohio Health Group HMO |
$41.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.15
|
| Rate for Payer: PHCS Commercial |
$53.11
|
| Rate for Payer: United Healthcare All Payer |
$48.68
|
|
|
ADRIAMYCIN 10MG/5MLVIAL
|
Facility
|
IP
|
$55.32
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
25002717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$53.11 |
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.15
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cigna Commercial |
$45.92
|
| Rate for Payer: First Health Commercial |
$52.55
|
| Rate for Payer: Humana Commercial |
$47.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.68
|
| Rate for Payer: Ohio Health Group HMO |
$41.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.15
|
| Rate for Payer: PHCS Commercial |
$53.11
|
| Rate for Payer: United Healthcare All Payer |
$48.68
|
|
