|
EPINEPHRINE DRIP NS4MG/250ML
|
Facility
|
IP
|
$268.41
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
25001836
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.89 |
| Max. Negotiated Rate |
$257.67 |
| Rate for Payer: Aetna Commercial |
$206.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.36
|
| Rate for Payer: Cash Price |
$134.21
|
| Rate for Payer: Cigna Commercial |
$222.78
|
| Rate for Payer: First Health Commercial |
$254.99
|
| Rate for Payer: Humana Commercial |
$228.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.20
|
| Rate for Payer: Ohio Health Group HMO |
$201.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.21
|
| Rate for Payer: PHCS Commercial |
$257.67
|
| Rate for Payer: United Healthcare All Payer |
$236.20
|
|
|
EPINEPHRINE PLATELET AGGREGAT
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
30000613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem Medicaid |
$24.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.91
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Humana KY Medicaid |
$24.91
|
| Rate for Payer: Humana Medicare Advantage |
$24.91
|
| Rate for Payer: Kentucky WC Medicaid |
$25.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
EPINEPHRINE PLATELET AGGREGAT
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
30000613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: Aetna Commercial |
$1,212.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$1,307.25
|
| Rate for Payer: First Health Commercial |
$1,496.25
|
| Rate for Payer: Humana Commercial |
$1,338.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$488.25
|
| Rate for Payer: PHCS Commercial |
$1,512.00
|
| Rate for Payer: United Healthcare All Payer |
$1,386.00
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: Aetna Commercial |
$1,212.75
|
| Rate for Payer: Anthem Medicaid |
$541.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$1,307.25
|
| Rate for Payer: First Health Commercial |
$1,496.25
|
| Rate for Payer: Humana Commercial |
$1,338.75
|
| Rate for Payer: Humana KY Medicaid |
$541.64
|
| Rate for Payer: Kentucky WC Medicaid |
$547.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$488.25
|
| Rate for Payer: PHCS Commercial |
$1,512.00
|
| Rate for Payer: United Healthcare All Payer |
$1,386.00
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Facility
|
OP
|
$817.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25001837
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.28 |
| Max. Negotiated Rate |
$784.80 |
| Rate for Payer: Aetna Commercial |
$629.48
|
| Rate for Payer: Anthem Medicaid |
$281.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$637.65
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cigna Commercial |
$678.52
|
| Rate for Payer: First Health Commercial |
$776.62
|
| Rate for Payer: Humana Commercial |
$694.88
|
| Rate for Payer: Humana KY Medicaid |
$281.14
|
| Rate for Payer: Kentucky WC Medicaid |
$284.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$670.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$603.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$719.40
|
| Rate for Payer: Ohio Health Group HMO |
$613.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.42
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,575.00
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$945.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,102.50
|
| Rate for Payer: UHCCP Medicaid |
$551.25
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: Aetna Commercial |
$1,212.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$1,307.25
|
| Rate for Payer: First Health Commercial |
$1,496.25
|
| Rate for Payer: Humana Commercial |
$1,338.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$488.25
|
| Rate for Payer: PHCS Commercial |
$1,512.00
|
| Rate for Payer: United Healthcare All Payer |
$1,386.00
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Facility
|
IP
|
$817.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25001837
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.28 |
| Max. Negotiated Rate |
$784.80 |
| Rate for Payer: Aetna Commercial |
$629.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$637.65
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cigna Commercial |
$678.52
|
| Rate for Payer: First Health Commercial |
$776.62
|
| Rate for Payer: Humana Commercial |
$694.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$670.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$603.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$245.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$719.40
|
| Rate for Payer: Ohio Health Group HMO |
$613.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.42
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: Aetna Commercial |
$1,212.75
|
| Rate for Payer: Anthem Medicaid |
$541.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$1,307.25
|
| Rate for Payer: First Health Commercial |
$1,496.25
|
| Rate for Payer: Humana Commercial |
$1,338.75
|
| Rate for Payer: Humana KY Medicaid |
$541.64
|
| Rate for Payer: Kentucky WC Medicaid |
$547.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$488.25
|
| Rate for Payer: PHCS Commercial |
$1,512.00
|
| Rate for Payer: United Healthcare All Payer |
$1,386.00
|
|
|
EPIPEN JR 0.15mg Syringe
|
Facility
|
IP
|
$1,597.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.69 |
| Max. Negotiated Rate |
$1,533.70 |
| Rate for Payer: Aetna Commercial |
$1,230.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,246.13
|
| Rate for Payer: Cash Price |
$798.80
|
| Rate for Payer: Cigna Commercial |
$1,326.01
|
| Rate for Payer: First Health Commercial |
$1,517.72
|
| Rate for Payer: Humana Commercial |
$1,357.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,310.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,179.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,405.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,198.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$495.26
|
| Rate for Payer: PHCS Commercial |
$1,533.70
|
| Rate for Payer: United Healthcare All Payer |
$1,405.89
|
|
|
EPIPEN JR 0.15mg Syringe
|
Facility
|
OP
|
$1,597.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.69 |
| Max. Negotiated Rate |
$1,533.70 |
| Rate for Payer: Aetna Commercial |
$1,230.15
|
| Rate for Payer: Anthem Medicaid |
$549.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,246.13
|
| Rate for Payer: Cash Price |
$798.80
|
| Rate for Payer: Cigna Commercial |
$1,326.01
|
| Rate for Payer: First Health Commercial |
$1,517.72
|
| Rate for Payer: Humana Commercial |
$1,357.96
|
| Rate for Payer: Humana KY Medicaid |
$549.41
|
| Rate for Payer: Kentucky WC Medicaid |
$555.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,310.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,179.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$560.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,405.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,198.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$495.26
|
| Rate for Payer: PHCS Commercial |
$1,533.70
|
| Rate for Payer: United Healthcare All Payer |
$1,405.89
|
|
|
EPIPEN JR 0.15mg Syringe
|
Professional
|
Both
|
$1,597.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,597.60 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,597.60
|
| Rate for Payer: Cash Price |
$798.80
|
| Rate for Payer: Cash Price |
$798.80
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$958.56
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,118.32
|
| Rate for Payer: UHCCP Medicaid |
$559.16
|
|
|
EPIPEN JR 0.15mg Syringe
|
Facility
|
IP
|
$1,597.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.69 |
| Max. Negotiated Rate |
$1,533.70 |
| Rate for Payer: Aetna Commercial |
$1,230.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,246.13
|
| Rate for Payer: Cash Price |
$798.80
|
| Rate for Payer: Cigna Commercial |
$1,326.01
|
| Rate for Payer: First Health Commercial |
$1,517.72
|
| Rate for Payer: Humana Commercial |
$1,357.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,310.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,179.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,405.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,198.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$495.26
|
| Rate for Payer: PHCS Commercial |
$1,533.70
|
| Rate for Payer: United Healthcare All Payer |
$1,405.89
|
|
|
EPIPEN JR 0.15mg Syringe
|
Facility
|
OP
|
$1,597.60
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.69 |
| Max. Negotiated Rate |
$1,533.70 |
| Rate for Payer: Aetna Commercial |
$1,230.15
|
| Rate for Payer: Anthem Medicaid |
$549.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,246.13
|
| Rate for Payer: Cash Price |
$798.80
|
| Rate for Payer: Cigna Commercial |
$1,326.01
|
| Rate for Payer: First Health Commercial |
$1,517.72
|
| Rate for Payer: Humana Commercial |
$1,357.96
|
| Rate for Payer: Humana KY Medicaid |
$549.41
|
| Rate for Payer: Kentucky WC Medicaid |
$555.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,310.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,179.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$560.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,405.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,198.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$495.26
|
| Rate for Payer: PHCS Commercial |
$1,533.70
|
| Rate for Payer: United Healthcare All Payer |
$1,405.89
|
|
|
EPIPEN JR 0.15mg Syringe
|
Facility
|
OP
|
$1,658.49
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004360
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$215.60 |
| Max. Negotiated Rate |
$1,592.15 |
| Rate for Payer: Aetna Commercial |
$1,277.04
|
| Rate for Payer: Anthem Medicaid |
$570.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,293.62
|
| Rate for Payer: Cash Price |
$829.24
|
| Rate for Payer: Cigna Commercial |
$1,376.55
|
| Rate for Payer: First Health Commercial |
$1,575.57
|
| Rate for Payer: Humana Commercial |
$1,409.72
|
| Rate for Payer: Humana KY Medicaid |
$570.35
|
| Rate for Payer: Kentucky WC Medicaid |
$576.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,359.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,223.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$497.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$581.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,459.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,243.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.13
|
| Rate for Payer: PHCS Commercial |
$1,592.15
|
| Rate for Payer: United Healthcare All Payer |
$1,459.47
|
|
|
EPIPEN JR 0.15mg Syringe
|
Facility
|
IP
|
$1,658.49
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004360
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$215.60 |
| Max. Negotiated Rate |
$1,592.15 |
| Rate for Payer: Aetna Commercial |
$1,277.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,293.62
|
| Rate for Payer: Cash Price |
$829.24
|
| Rate for Payer: Cigna Commercial |
$1,376.55
|
| Rate for Payer: First Health Commercial |
$1,575.57
|
| Rate for Payer: Humana Commercial |
$1,409.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,359.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,223.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$497.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,459.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,243.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.13
|
| Rate for Payer: PHCS Commercial |
$1,592.15
|
| Rate for Payer: United Healthcare All Payer |
$1,459.47
|
|
|
EPIRUBICIN 2MG (50 MG/25 ML) C
|
Facility
|
IP
|
$254.46
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
25002609
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.08 |
| Max. Negotiated Rate |
$244.28 |
| Rate for Payer: Aetna Commercial |
$195.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$198.48
|
| Rate for Payer: Cash Price |
$127.23
|
| Rate for Payer: Cigna Commercial |
$211.20
|
| Rate for Payer: First Health Commercial |
$241.74
|
| Rate for Payer: Humana Commercial |
$216.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$208.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$187.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$223.92
|
| Rate for Payer: Ohio Health Group HMO |
$190.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.88
|
| Rate for Payer: PHCS Commercial |
$244.28
|
| Rate for Payer: United Healthcare All Payer |
$223.92
|
|
|
EPIRUBICIN 2MG (50 MG/25 ML) C
|
Facility
|
OP
|
$254.46
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
25002609
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.08 |
| Max. Negotiated Rate |
$244.28 |
| Rate for Payer: Aetna Commercial |
$195.93
|
| Rate for Payer: Anthem Medicaid |
$87.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$198.48
|
| Rate for Payer: Cash Price |
$127.23
|
| Rate for Payer: Cigna Commercial |
$211.20
|
| Rate for Payer: First Health Commercial |
$241.74
|
| Rate for Payer: Humana Commercial |
$216.29
|
| Rate for Payer: Humana KY Medicaid |
$87.51
|
| Rate for Payer: Kentucky WC Medicaid |
$88.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$208.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$187.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$223.92
|
| Rate for Payer: Ohio Health Group HMO |
$190.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.88
|
| Rate for Payer: PHCS Commercial |
$244.28
|
| Rate for Payer: United Healthcare All Payer |
$223.92
|
|
|
EPISIOTOMY OR VAGINAL REPAI(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
720P0013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.92
|
| Rate for Payer: Anthem Medicaid |
$86.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$220.05
|
| Rate for Payer: Healthspan PPO |
$225.04
|
| Rate for Payer: Humana Medicaid |
$86.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.15
|
| Rate for Payer: Molina Healthcare Passport |
$86.42
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$78.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.28
|
|
|
EPISIOTOMY OR VAGINAL REPAIR
|
Professional
|
Both
|
$4,081.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
72000013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$4,081.00 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.92
|
| Rate for Payer: Anthem Medicaid |
$86.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,081.00
|
| Rate for Payer: Cash Price |
$2,040.50
|
| Rate for Payer: Cash Price |
$2,040.50
|
| Rate for Payer: Cigna Commercial |
$220.05
|
| Rate for Payer: Healthspan PPO |
$225.04
|
| Rate for Payer: Humana Medicaid |
$86.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.15
|
| Rate for Payer: Molina Healthcare Passport |
$86.42
|
| Rate for Payer: Multiplan PHCS |
$2,448.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,856.70
|
| Rate for Payer: UHCCP Medicaid |
$78.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.28
|
|
|
EPISIOTOMY OR VAGINAL REPAIR
|
Facility
|
OP
|
$4,081.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
72000013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$530.53 |
| Max. Negotiated Rate |
$3,917.76 |
| Rate for Payer: Aetna Commercial |
$3,142.37
|
| Rate for Payer: Anthem Medicaid |
$1,403.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,183.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,040.50
|
| Rate for Payer: Cash Price |
$2,040.50
|
| Rate for Payer: Cigna Commercial |
$3,387.23
|
| Rate for Payer: First Health Commercial |
$3,876.95
|
| Rate for Payer: Humana Commercial |
$3,468.85
|
| Rate for Payer: Humana KY Medicaid |
$1,403.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,417.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,346.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,011.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,431.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,591.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,060.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$816.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$530.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,265.11
|
| Rate for Payer: PHCS Commercial |
$3,917.76
|
| Rate for Payer: United Healthcare All Payer |
$3,591.28
|
|
|
EPISIOTOMY OR VAGINAL REPAIR
|
Facility
|
IP
|
$4,081.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
72000013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$530.53 |
| Max. Negotiated Rate |
$3,917.76 |
| Rate for Payer: Aetna Commercial |
$3,142.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,183.18
|
| Rate for Payer: Cash Price |
$2,040.50
|
| Rate for Payer: Cigna Commercial |
$3,387.23
|
| Rate for Payer: First Health Commercial |
$3,876.95
|
| Rate for Payer: Humana Commercial |
$3,468.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,346.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,011.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,591.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,060.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$816.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$530.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,265.11
|
| Rate for Payer: PHCS Commercial |
$3,917.76
|
| Rate for Payer: United Healthcare All Payer |
$3,591.28
|
|
|
EPISIOTOMY OR VAGINAL REPAI(T
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
720T0013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$485.03 |
| Max. Negotiated Rate |
$3,581.76 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.61
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
EPISIOTOMY OR VAGINAL REPAI(T
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
720T0013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$485.03 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem Medicaid |
$1,283.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Humana KY Medicaid |
$1,283.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.61
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
