|
AL .75 SH 6F 100CM
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
ALAIR BRONCH THERMO CATH
|
Facility
|
IP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
ALAIR BRONCH THERMO CATH
|
Facility
|
OP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem Medicaid |
$4,272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Humana KY Medicaid |
$4,272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,316.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
ALBUMIN 25% (25GM/100ML)
|
Facility
|
OP
|
$542.80
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
25002699
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.08 |
| Max. Negotiated Rate |
$521.09 |
| Rate for Payer: Aetna Commercial |
$417.96
|
| Rate for Payer: Anthem Medicaid |
$186.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$53.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.65
|
| Rate for Payer: Cash Price |
$271.40
|
| Rate for Payer: Cash Price |
$271.40
|
| Rate for Payer: Cigna Commercial |
$450.52
|
| Rate for Payer: First Health Commercial |
$515.66
|
| Rate for Payer: Humana Commercial |
$461.38
|
| Rate for Payer: Humana KY Medicaid |
$186.67
|
| Rate for Payer: Humana Medicare Advantage |
$53.08
|
| Rate for Payer: Kentucky WC Medicaid |
$188.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.66
|
| Rate for Payer: Ohio Health Group HMO |
$407.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.27
|
| Rate for Payer: PHCS Commercial |
$521.09
|
| Rate for Payer: United Healthcare All Payer |
$477.66
|
|
|
ALBUMIN 25% (25GM/100ML)
|
Facility
|
IP
|
$542.80
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
25002699
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$521.09 |
| Rate for Payer: Aetna Commercial |
$417.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.38
|
| Rate for Payer: Cash Price |
$271.40
|
| Rate for Payer: Cigna Commercial |
$450.52
|
| Rate for Payer: First Health Commercial |
$515.66
|
| Rate for Payer: Humana Commercial |
$461.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.66
|
| Rate for Payer: Ohio Health Group HMO |
$407.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.27
|
| Rate for Payer: PHCS Commercial |
$521.09
|
| Rate for Payer: United Healthcare All Payer |
$477.66
|
|
|
ALBUMIN 25% 50ML (12.5GM/50ML)
|
Facility
|
IP
|
$326.40
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
25003776
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$313.34 |
| Rate for Payer: Aetna Commercial |
$251.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$254.59
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$270.91
|
| Rate for Payer: First Health Commercial |
$310.08
|
| Rate for Payer: Humana Commercial |
$277.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$267.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$240.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.23
|
| Rate for Payer: Ohio Health Group HMO |
$244.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.18
|
| Rate for Payer: PHCS Commercial |
$313.34
|
| Rate for Payer: United Healthcare All Payer |
$287.23
|
|
|
ALBUMIN 25% 50ML (12.5GM/50ML)
|
Facility
|
OP
|
$326.40
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
25003776
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$313.34 |
| Rate for Payer: Aetna Commercial |
$251.33
|
| Rate for Payer: Anthem Medicaid |
$112.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$53.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$254.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.65
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cigna Commercial |
$270.91
|
| Rate for Payer: First Health Commercial |
$310.08
|
| Rate for Payer: Humana Commercial |
$277.44
|
| Rate for Payer: Humana KY Medicaid |
$112.25
|
| Rate for Payer: Humana Medicare Advantage |
$53.08
|
| Rate for Payer: Kentucky WC Medicaid |
$113.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$267.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$240.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.23
|
| Rate for Payer: Ohio Health Group HMO |
$244.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.18
|
| Rate for Payer: PHCS Commercial |
$313.34
|
| Rate for Payer: United Healthcare All Payer |
$287.23
|
|
|
ALBUMIN 5% (12.5GM/250ML)
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
25002698
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.67 |
| Max. Negotiated Rate |
$344.64 |
| Rate for Payer: Aetna Commercial |
$276.43
|
| Rate for Payer: Anthem Medicaid |
$123.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$53.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.65
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$297.97
|
| Rate for Payer: First Health Commercial |
$341.05
|
| Rate for Payer: Humana Commercial |
$305.15
|
| Rate for Payer: Humana KY Medicaid |
$123.46
|
| Rate for Payer: Humana Medicare Advantage |
$53.08
|
| Rate for Payer: Kentucky WC Medicaid |
$124.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$125.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.92
|
| Rate for Payer: Ohio Health Group HMO |
$269.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.29
|
| Rate for Payer: PHCS Commercial |
$344.64
|
| Rate for Payer: United Healthcare All Payer |
$315.92
|
|
|
ALBUMIN 5% (12.5GM/250ML)
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
25002698
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.67 |
| Max. Negotiated Rate |
$344.64 |
| Rate for Payer: Aetna Commercial |
$276.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.02
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$297.97
|
| Rate for Payer: First Health Commercial |
$341.05
|
| Rate for Payer: Humana Commercial |
$305.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.92
|
| Rate for Payer: Ohio Health Group HMO |
$269.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.29
|
| Rate for Payer: PHCS Commercial |
$344.64
|
| Rate for Payer: United Healthcare All Payer |
$315.92
|
|
|
ALBUMIN 5% 250ML (25GM 500ML)
|
Facility
|
OP
|
$608.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
25002697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.08 |
| Max. Negotiated Rate |
$583.68 |
| Rate for Payer: Aetna Commercial |
$468.16
|
| Rate for Payer: Anthem Medicaid |
$209.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$53.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$474.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.65
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cigna Commercial |
$504.64
|
| Rate for Payer: First Health Commercial |
$577.60
|
| Rate for Payer: Humana Commercial |
$516.80
|
| Rate for Payer: Humana KY Medicaid |
$209.09
|
| Rate for Payer: Humana Medicare Advantage |
$53.08
|
| Rate for Payer: Kentucky WC Medicaid |
$211.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$498.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$448.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$213.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$535.04
|
| Rate for Payer: Ohio Health Group HMO |
$456.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.48
|
| Rate for Payer: PHCS Commercial |
$583.68
|
| Rate for Payer: United Healthcare All Payer |
$535.04
|
|
|
ALBUMIN 5% 250ML (25GM 500ML)
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
25002697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.04 |
| Max. Negotiated Rate |
$583.68 |
| Rate for Payer: Aetna Commercial |
$468.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$474.24
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cigna Commercial |
$504.64
|
| Rate for Payer: First Health Commercial |
$577.60
|
| Rate for Payer: Humana Commercial |
$516.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$498.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$448.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$182.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$535.04
|
| Rate for Payer: Ohio Health Group HMO |
$456.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.48
|
| Rate for Payer: PHCS Commercial |
$583.68
|
| Rate for Payer: United Healthcare All Payer |
$535.04
|
|
|
ALBUMIN FLUID
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
30001790
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
ALBUMIN FLUID
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
30001790
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.78
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$7.78
|
| Rate for Payer: Humana Medicare Advantage |
$7.78
|
| Rate for Payer: Kentucky WC Medicaid |
$7.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
ALBUMIN FLUID
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
30001790
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$4.56
|
| Rate for Payer: Healthspan PPO |
$5.42
|
| Rate for Payer: Multiplan PHCS |
$27.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.20
|
| Rate for Payer: UHCCP Medicaid |
$16.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.67
|
|
|
ALBUMIN - SERUM
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
30000225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
ALBUMIN - SERUM
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
30000225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$4.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.95
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Humana KY Medicaid |
$4.95
|
| Rate for Payer: Humana Medicare Advantage |
$4.95
|
| Rate for Payer: Kentucky WC Medicaid |
$5.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
ALBUTEROL 1 puff (18gm MDI)
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
ALBUTEROL 1 puff (18gm MDI)
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
ALBUTEROL 1 puff (6.7gm MDI)
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004365
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
ALBUTEROL 1 puff (6.7gm MDI)
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004365
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
ALBUTEROL 1 puff (8.5gm MDI)
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004367
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.16
|
| Rate for Payer: Humana Commercial |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
ALBUTEROL 1 puff (8.5gm MDI)
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004367
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.16
|
| Rate for Payer: Humana Commercial |
$3.72
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
ALBUTEROL 1 puff (8gm MDI)
|
Facility
|
OP
|
$4.58
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.80
|
| Rate for Payer: First Health Commercial |
$4.35
|
| Rate for Payer: Humana Commercial |
$3.89
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.03
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Payer |
$4.03
|
|
|
ALBUTEROL 1 puff (8gm MDI)
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.40 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.57
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.80
|
| Rate for Payer: First Health Commercial |
$4.35
|
| Rate for Payer: Humana Commercial |
$3.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.03
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Payer |
$4.03
|
|
|
ALBUTEROL 2.5MG/0.5ML SOLN
|
Facility
|
OP
|
$4.70
|
|
|
Service Code
|
NDC 487990130
|
| Hospital Charge Code |
25000176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Anthem Medicaid |
$1.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.90
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Humana KY Medicaid |
$1.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.46
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
