|
EPINEPHRINE[0.1MG]1MG/10ML SYR
|
Facility
|
IP
|
$119.50
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
25001835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$114.72 |
| Rate for Payer: Aetna Commercial |
$92.02
|
| Rate for Payer: Aetna Commercial |
$92.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.18
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Cash Price |
$60.37
|
| Rate for Payer: Cigna Commercial |
$99.19
|
| Rate for Payer: Cigna Commercial |
$100.21
|
| Rate for Payer: First Health Commercial |
$114.70
|
| Rate for Payer: First Health Commercial |
$113.53
|
| Rate for Payer: Humana Commercial |
$102.63
|
| Rate for Payer: Humana Commercial |
$101.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.25
|
| Rate for Payer: Ohio Health Group HMO |
$89.62
|
| Rate for Payer: Ohio Health Group HMO |
$90.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.45
|
| Rate for Payer: PHCS Commercial |
$114.72
|
| Rate for Payer: PHCS Commercial |
$115.91
|
| Rate for Payer: United Healthcare All Payer |
$105.16
|
| Rate for Payer: United Healthcare All Payer |
$106.25
|
|
|
EPINEPHRINE[0.1MG]1MG/10ML SYR
|
Facility
|
OP
|
$119.50
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
25001835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$114.72 |
| Rate for Payer: Aetna Commercial |
$92.02
|
| Rate for Payer: Aetna Commercial |
$92.97
|
| Rate for Payer: Anthem Medicaid |
$41.10
|
| Rate for Payer: Anthem Medicaid |
$41.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.18
|
| Rate for Payer: Cash Price |
$59.75
|
| Rate for Payer: Cash Price |
$60.37
|
| Rate for Payer: Cigna Commercial |
$100.21
|
| Rate for Payer: Cigna Commercial |
$99.19
|
| Rate for Payer: First Health Commercial |
$114.70
|
| Rate for Payer: First Health Commercial |
$113.53
|
| Rate for Payer: Humana Commercial |
$101.58
|
| Rate for Payer: Humana Commercial |
$102.63
|
| Rate for Payer: Humana KY Medicaid |
$41.10
|
| Rate for Payer: Humana KY Medicaid |
$41.52
|
| Rate for Payer: Kentucky WC Medicaid |
$41.95
|
| Rate for Payer: Kentucky WC Medicaid |
$41.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.25
|
| Rate for Payer: Ohio Health Group HMO |
$89.62
|
| Rate for Payer: Ohio Health Group HMO |
$90.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.31
|
| Rate for Payer: PHCS Commercial |
$115.91
|
| Rate for Payer: PHCS Commercial |
$114.72
|
| Rate for Payer: United Healthcare All Payer |
$106.25
|
| Rate for Payer: United Healthcare All Payer |
$105.16
|
|
|
EPINEPHRINE 0.1MG (1MG SDV)
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
25001834
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
EPINEPHRINE 0.1MG (1MG SDV)
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
25001834
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem Medicaid |
$40.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Humana KY Medicaid |
$40.58
|
| Rate for Payer: Kentucky WC Medicaid |
$40.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
EPINEPHRINE 0.1mg/ml (GEN) SDV
|
Facility
|
OP
|
$11.80
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
636T0234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Aetna Commercial |
$9.09
|
| Rate for Payer: Anthem Medicaid |
$4.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.20
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna Commercial |
$9.79
|
| Rate for Payer: First Health Commercial |
$11.21
|
| Rate for Payer: Humana Commercial |
$10.03
|
| Rate for Payer: Humana KY Medicaid |
$4.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.38
|
| Rate for Payer: Ohio Health Group HMO |
$8.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.14
|
| Rate for Payer: PHCS Commercial |
$11.33
|
| Rate for Payer: United Healthcare All Payer |
$10.38
|
|
|
EPINEPHRINE 0.1mg/ml (GEN) SDV
|
Facility
|
OP
|
$11.80
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Aetna Commercial |
$9.09
|
| Rate for Payer: Anthem Medicaid |
$4.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.20
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna Commercial |
$9.79
|
| Rate for Payer: First Health Commercial |
$11.21
|
| Rate for Payer: Humana Commercial |
$10.03
|
| Rate for Payer: Humana KY Medicaid |
$4.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.38
|
| Rate for Payer: Ohio Health Group HMO |
$8.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.14
|
| Rate for Payer: PHCS Commercial |
$11.33
|
| Rate for Payer: United Healthcare All Payer |
$10.38
|
|
|
EPINEPHRINE 0.1mg/ml (GEN) SDV
|
Professional
|
Both
|
$11.80
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Ambetter Exchange |
$2.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.74
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.28
|
| Rate for Payer: Multiplan PHCS |
$7.08
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.96
|
| Rate for Payer: UHCCP Medicaid |
$4.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.28
|
|
|
EPINEPHRINE 0.1mg/ml (GEN) SDV
|
Facility
|
IP
|
$11.80
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
636T0234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Aetna Commercial |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.20
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna Commercial |
$9.79
|
| Rate for Payer: First Health Commercial |
$11.21
|
| Rate for Payer: Humana Commercial |
$10.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.38
|
| Rate for Payer: Ohio Health Group HMO |
$8.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.14
|
| Rate for Payer: PHCS Commercial |
$11.33
|
| Rate for Payer: United Healthcare All Payer |
$10.38
|
|
|
EPINEPHRINE 0.1mg/ml (GEN) SDV
|
Facility
|
IP
|
$11.80
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$11.33 |
| Rate for Payer: Aetna Commercial |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.20
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna Commercial |
$9.79
|
| Rate for Payer: First Health Commercial |
$11.21
|
| Rate for Payer: Humana Commercial |
$10.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.38
|
| Rate for Payer: Ohio Health Group HMO |
$8.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.14
|
| Rate for Payer: PHCS Commercial |
$11.33
|
| Rate for Payer: United Healthcare All Payer |
$10.38
|
|
|
EPINEPHRINE DRIP NS4MG/250ML
|
Facility
|
IP
|
$268.41
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
25001836
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.52 |
| 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 |
$214.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.20
|
| Rate for Payer: PHCS Commercial |
$257.67
|
| Rate for Payer: United Healthcare All Payer |
$236.20
|
|
|
EPINEPHRINE DRIP NS4MG/250ML
|
Facility
|
OP
|
$268.41
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
25001836
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$257.67 |
| Rate for Payer: Aetna Commercial |
$206.68
|
| Rate for Payer: Anthem Medicaid |
$92.31
|
| 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: Humana KY Medicaid |
$92.31
|
| Rate for Payer: Kentucky WC Medicaid |
$93.25
|
| 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: Molina Healthcare Medicaid |
$94.16
|
| 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 |
$214.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.20
|
| Rate for Payer: PHCS Commercial |
$257.67
|
| Rate for Payer: United Healthcare All Payer |
$236.20
|
|
|
EPINEPHRINE PLATELET AGGREGAT
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
30000613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
EPINEPHRINE PLATELET AGGREGAT
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 85576
|
| Hospital Charge Code |
30000613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$24.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.91
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| 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 |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Facility
|
IP
|
$817.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$245.25 |
| 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 |
$654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.08
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Facility
|
OP
|
$817.50
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
25001837
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$245.25 |
| 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 |
$654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.08
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Facility
|
OP
|
$817.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$245.25 |
| 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 |
$654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.08
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Facility
|
IP
|
$817.50
|
|
|
Service Code
|
HCPCS J0165
|
| Hospital Charge Code |
25001837
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$245.25 |
| 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 |
$654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.08
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Professional
|
Both
|
$817.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$572.25 |
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Cash Price |
$408.75
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$490.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$572.25
|
| Rate for Payer: UHCCP Medicaid |
$286.12
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Facility
|
OP
|
$817.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$245.25 |
| 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 |
$654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.08
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
EPIPEN0.01MG[0.3MG/0.3MLPENINJ
|
Facility
|
IP
|
$817.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$245.25 |
| 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 |
$654.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.08
|
| Rate for Payer: PHCS Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Payer |
$719.40
|
|
|
EPIPEN JR 0.15mg Syringe
|
Professional
|
Both
|
$1,658.49
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,160.94 |
| Rate for Payer: Cash Price |
$829.24
|
| Rate for Payer: Cash Price |
$829.24
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$995.09
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,160.94
|
| Rate for Payer: UHCCP Medicaid |
$580.47
|
|
|
EPIPEN JR 0.15mg Syringe
|
Facility
|
OP
|
$1,658.49
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$497.55 |
| 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 |
$1,326.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,442.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,144.36
|
| 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 |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$497.55 |
| 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 |
$1,326.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,442.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,144.36
|
| 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 |
636T0186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$497.55 |
| 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 |
$1,326.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,442.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,144.36
|
| Rate for Payer: PHCS Commercial |
$1,592.15
|
| Rate for Payer: United Healthcare All Payer |
$1,459.47
|
|
|
EPIPEN JR 0.15mg Syringe
|
Facility
|
OP
|
$1,658.49
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$497.55 |
| 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 |
$1,326.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,442.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,144.36
|
| Rate for Payer: PHCS Commercial |
$1,592.15
|
| Rate for Payer: United Healthcare All Payer |
$1,459.47
|
|
