|
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 |
$0.02 |
| 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 |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.05
|
| Rate for Payer: PHCS Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Payer |
$0.06
|
|
|
ADRENALECTOMY PART OR COMPLETE
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 60540
|
| Hospital Charge Code |
76102281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| 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 |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
ADRENALECTOMY PART OR COMPLETE
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 60540
|
| Hospital Charge Code |
76102281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| 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 |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| 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 |
$1,606.50 |
| Rate for Payer: Aetna Commercial |
$1,606.50
|
| Rate for Payer: Ambetter Exchange |
$1,025.38
|
| Rate for Payer: Anthem Medicaid |
$835.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,025.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,025.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,230.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,025.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.38
|
| 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 |
$1,332.99
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$843.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,025.38
|
|
|
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 |
$1,606.50 |
| Rate for Payer: Aetna Commercial |
$1,606.50
|
| Rate for Payer: Ambetter Exchange |
$1,025.38
|
| Rate for Payer: Anthem Medicaid |
$835.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,025.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,025.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,230.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,025.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.38
|
| 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 |
$1,332.99
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$843.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,025.38
|
|
|
ADRENALIN CHLORIDE 0.1MG
|
Facility
|
OP
|
$830.57
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
25001833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$249.17 |
| 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 |
$664.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.09
|
| Rate for Payer: PHCS Commercial |
$797.35
|
| Rate for Payer: United Healthcare All Payer |
$730.90
|
|
|
ADRENALIN CHLORIDE 0.1MG
|
Facility
|
IP
|
$830.57
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
25001833
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$249.17 |
| 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 |
$664.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.09
|
| Rate for Payer: PHCS Commercial |
$797.35
|
| Rate for Payer: United Healthcare All Payer |
$730.90
|
|
|
ADRENALIN(EPI)1/1000NASSOL30ML
|
Facility
|
OP
|
$28.52
|
|
|
Service Code
|
NDC 42023010301
|
| Hospital Charge Code |
25002807
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.56 |
| 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 |
$22.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.68
|
| Rate for Payer: PHCS Commercial |
$27.38
|
| Rate for Payer: United Healthcare All Payer |
$25.10
|
|
|
ADRENALIN(EPI)1/1000NASSOL30ML
|
Facility
|
IP
|
$28.52
|
|
|
Service Code
|
NDC 42023010301
|
| Hospital Charge Code |
25002807
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.56 |
| 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 |
$22.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.68
|
| Rate for Payer: PHCS Commercial |
$27.38
|
| Rate for Payer: United Healthcare All Payer |
$25.10
|
|
|
ADRENALS US LTD
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
ADRENALS US LTD
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$700.20 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$700.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$408.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
ADRENALS US LTD
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,120.32 |
| Rate for Payer: Aetna Commercial |
$898.59
|
| Rate for Payer: Anthem Medicaid |
$401.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$968.61
|
| Rate for Payer: First Health Commercial |
$1,108.65
|
| Rate for Payer: Humana Commercial |
$991.95
|
| Rate for Payer: Humana KY Medicaid |
$401.33
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$405.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.96
|
| Rate for Payer: Ohio Health Group HMO |
$875.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.23
|
| Rate for Payer: PHCS Commercial |
$1,120.32
|
| Rate for Payer: United Healthcare All Payer |
$1,026.96
|
|
|
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: Ambetter Exchange |
$78.47
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.16
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$78.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.47
|
| 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 |
$102.01
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.47
|
|
|
ADRENALS US LTD(T
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem Medicaid |
$358.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Humana KY Medicaid |
$358.34
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$361.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$365.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
ADRENALS US LTD(T
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
402T0015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.60 |
| Max. Negotiated Rate |
$1,000.32 |
| Rate for Payer: Aetna Commercial |
$802.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$812.76
|
| Rate for Payer: Cash Price |
$521.00
|
| Rate for Payer: Cigna Commercial |
$864.86
|
| Rate for Payer: First Health Commercial |
$989.90
|
| Rate for Payer: Humana Commercial |
$885.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$854.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$769.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$916.96
|
| Rate for Payer: Ohio Health Group HMO |
$781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$833.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$718.98
|
| Rate for Payer: PHCS Commercial |
$1,000.32
|
| Rate for Payer: United Healthcare All Payer |
$916.96
|
|
|
ADRIAMYCIN 10MG (50MG VL)
|
Facility
|
IP
|
$133.91
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
25002557
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.17 |
| 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 |
$107.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.40
|
| Rate for Payer: PHCS Commercial |
$128.55
|
| Rate for Payer: United Healthcare All Payer |
$117.84
|
|
|
ADRIAMYCIN 10MG (50MG VL)
|
Facility
|
OP
|
$133.91
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
25002557
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.17 |
| 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 |
$107.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.40
|
| 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 |
$16.60 |
| 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 |
$44.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.17
|
| 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 |
$16.60 |
| 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 |
$44.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.17
|
| Rate for Payer: PHCS Commercial |
$53.11
|
| Rate for Payer: United Healthcare All Payer |
$48.68
|
|
|
ADROIT IM SH GUIDE CATH 6F
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ADROIT IM SH GUIDE CATH 6F
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ADROIT JL 3.5 GUIDE CATH 6F
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ADROIT JL 3.5 GUIDE CATH 6F
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ADROIT JL 3 GUIDE CATH 6F
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
ADROIT JL 3 GUIDE CATH 6F
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
