|
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 |
$97.92 |
| Max. Negotiated Rate |
$313.34 |
| Rate for Payer: Aetna Commercial |
$251.33
|
| Rate for Payer: Anthem Medicaid |
$112.25
|
| 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: Humana KY Medicaid |
$112.25
|
| 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 |
$97.92
|
| 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 |
$261.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.22
|
| Rate for Payer: PHCS Commercial |
$313.34
|
| Rate for Payer: United Healthcare All Payer |
$287.23
|
|
|
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 |
$97.92 |
| 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 |
$261.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.22
|
| Rate for Payer: PHCS Commercial |
$313.34
|
| Rate for Payer: United Healthcare All Payer |
$287.23
|
|
|
ALBUMIN 5% (12.5GM/250ML)
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
25002698
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.70 |
| 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 |
$287.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.71
|
| Rate for Payer: PHCS Commercial |
$344.64
|
| Rate for Payer: United Healthcare All Payer |
$315.92
|
|
|
ALBUMIN 5% (12.5GM/250ML)
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
25002698
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.08 |
| 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 |
$71.66
|
| 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 |
$63.70
|
| 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 |
$287.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.71
|
| Rate for Payer: PHCS Commercial |
$344.64
|
| Rate for Payer: United Healthcare All Payer |
$315.92
|
|
|
ALBUMIN 5% 250ML (25GM 500ML)
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
25002697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.40 |
| 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 |
$486.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$528.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$419.52
|
| Rate for Payer: PHCS Commercial |
$583.68
|
| Rate for Payer: United Healthcare All Payer |
$535.04
|
|
|
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 |
$71.66
|
| 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 |
$63.70
|
| 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 |
$486.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$528.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$419.52
|
| Rate for Payer: PHCS Commercial |
$583.68
|
| Rate for Payer: United Healthcare All Payer |
$535.04
|
|
|
ALBUMIN FLUID
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
30001790
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$29.40 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Ambetter Exchange |
$7.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.34
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$4.56
|
| Rate for Payer: Healthspan PPO |
$5.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.78
|
| Rate for Payer: Multiplan PHCS |
$29.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.11
|
| Rate for Payer: UHCCP Medicaid |
$17.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.78
|
|
|
ALBUMIN FLUID
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
30001790
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.35
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.81
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
ALBUMIN FLUID
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
30001790
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem Medicaid |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.78
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| 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 |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.81
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
ALBUMIN - SERUM
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
30000225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.09
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
ALBUMIN - SERUM
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
30000225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem Medicaid |
$4.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.95
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| 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 |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.09
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
ALBUTEROL 1 puff (18gm MDI)
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| 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 |
$3.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
ALBUTEROL 1 puff (18gm MDI)
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004368
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| 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 |
$3.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
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 |
$1.30 |
| 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 |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
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 |
$1.30 |
| 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 |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
ALBUTEROL 1 puff (8.5gm MDI)
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004367
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| 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 |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
ALBUTEROL 1 puff (8.5gm MDI)
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004367
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| 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 |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
ALBUTEROL 1 puff (8gm MDI)
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| 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 |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.16
|
| Rate for Payer: PHCS Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Payer |
$4.03
|
|
|
ALBUTEROL 1 puff (8gm MDI)
|
Facility
|
OP
|
$4.58
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004366
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| 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 |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.16
|
| Rate for Payer: PHCS Commercial |
$4.40
|
| Rate for Payer: United Healthcare All Payer |
$4.03
|
|
|
ALBUTEROL 2.5MG/0.5ML SOLN
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 487990130
|
| Hospital Charge Code |
25000176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| 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: 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: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
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 |
$1.41 |
| 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 |
$3.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
ALBUTEROL HFA 18 GM
|
Facility
|
OP
|
$292.02
|
|
|
Service Code
|
NDC 173068220
|
| Hospital Charge Code |
25003964
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.61 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$224.86
|
| Rate for Payer: Anthem Medicaid |
$100.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.78
|
| Rate for Payer: Cash Price |
$146.01
|
| Rate for Payer: Cigna Commercial |
$242.38
|
| Rate for Payer: First Health Commercial |
$277.42
|
| Rate for Payer: Humana Commercial |
$248.22
|
| Rate for Payer: Humana KY Medicaid |
$100.43
|
| Rate for Payer: Kentucky WC Medicaid |
$101.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.98
|
| Rate for Payer: Ohio Health Group HMO |
$219.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.49
|
| Rate for Payer: PHCS Commercial |
$280.34
|
| Rate for Payer: United Healthcare All Payer |
$256.98
|
|
|
ALBUTEROL HFA 18 GM
|
Facility
|
IP
|
$292.02
|
|
|
Service Code
|
NDC 173068220
|
| Hospital Charge Code |
25003964
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.61 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$224.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.78
|
| Rate for Payer: Cash Price |
$146.01
|
| Rate for Payer: Cigna Commercial |
$242.38
|
| Rate for Payer: First Health Commercial |
$277.42
|
| Rate for Payer: Humana Commercial |
$248.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.98
|
| Rate for Payer: Ohio Health Group HMO |
$219.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.49
|
| Rate for Payer: PHCS Commercial |
$280.34
|
| Rate for Payer: United Healthcare All Payer |
$256.98
|
|
|
ALBUTEROL HFA 200 PUFF/8.5 GM
|
Facility
|
OP
|
$176.98
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25000178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$169.90 |
| Rate for Payer: Aetna Commercial |
$136.27
|
| Rate for Payer: Anthem Medicaid |
$60.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.04
|
| Rate for Payer: Cash Price |
$88.49
|
| Rate for Payer: Cigna Commercial |
$146.89
|
| Rate for Payer: First Health Commercial |
$168.13
|
| Rate for Payer: Humana Commercial |
$150.43
|
| Rate for Payer: Humana KY Medicaid |
$60.86
|
| Rate for Payer: Kentucky WC Medicaid |
$61.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$130.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$155.74
|
| Rate for Payer: Ohio Health Group HMO |
$132.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.12
|
| Rate for Payer: PHCS Commercial |
$169.90
|
| Rate for Payer: United Healthcare All Payer |
$155.74
|
|
|
ALBUTEROL HFA 200 PUFF/8.5 GM
|
Facility
|
IP
|
$176.98
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25000178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$169.90 |
| Rate for Payer: Aetna Commercial |
$136.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.04
|
| Rate for Payer: Cash Price |
$88.49
|
| Rate for Payer: Cigna Commercial |
$146.89
|
| Rate for Payer: First Health Commercial |
$168.13
|
| Rate for Payer: Humana Commercial |
$150.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$130.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$155.74
|
| Rate for Payer: Ohio Health Group HMO |
$132.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.12
|
| Rate for Payer: PHCS Commercial |
$169.90
|
| Rate for Payer: United Healthcare All Payer |
$155.74
|
|
