|
EST PT LOW LEVEL 2(T
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
510T0007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.28
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
EST PT LOW LEVEL 2(T
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
510T0007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem Medicaid |
$94.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.28
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Humana KY Medicaid |
$94.92
|
| Rate for Payer: Kentucky WC Medicaid |
$95.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
EST PT LOW LEVEL 2(T
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.92 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem Medicaid |
$94.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Humana KY Medicaid |
$94.92
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$95.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
EST PT MID LEVEL 3
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.10 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.86
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$336.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.03
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
EST PT MID LEVEL 3
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Aetna Commercial |
$70.77
|
| Rate for Payer: Ambetter Exchange |
$62.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.74
|
| Rate for Payer: Anthem Medicaid |
$42.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$62.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$62.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.63
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$89.85
|
| Rate for Payer: Healthspan PPO |
$70.91
|
| Rate for Payer: Humana Medicaid |
$42.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$62.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.48
|
| Rate for Payer: Molina Healthcare Passport |
$42.63
|
| Rate for Payer: Multiplan PHCS |
$232.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.85
|
| Rate for Payer: UHCCP Medicaid |
$35.43
|
| Rate for Payer: United Healthcare Non-Options |
$48.74
|
| Rate for Payer: United Healthcare Options |
$39.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$62.19
|
|
|
EST PT MID LEVEL 3
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.10 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem Medicaid |
$133.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.86
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Humana KY Medicaid |
$133.09
|
| Rate for Payer: Kentucky WC Medicaid |
$134.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$135.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$336.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.03
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
EST PT MID LEVEL 3
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.10 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.86
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$336.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.03
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
EST PT MID LEVEL 3
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem Medicaid |
$133.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Humana KY Medicaid |
$133.09
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$134.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$135.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$336.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.03
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
EST PT MID LEVEL 3(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
510P0008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$89.85 |
| Rate for Payer: Aetna Commercial |
$70.77
|
| Rate for Payer: Ambetter Exchange |
$62.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.74
|
| Rate for Payer: Anthem Medicaid |
$42.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$62.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$62.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.63
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$89.85
|
| Rate for Payer: Healthspan PPO |
$70.91
|
| Rate for Payer: Humana Medicaid |
$42.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$62.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.48
|
| Rate for Payer: Molina Healthcare Passport |
$42.63
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.85
|
| Rate for Payer: UHCCP Medicaid |
$35.43
|
| Rate for Payer: United Healthcare Non-Options |
$48.74
|
| Rate for Payer: United Healthcare Options |
$39.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$62.19
|
|
|
EST PT MID LEVEL 3(T
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
EST PT MID LEVEL 3(T
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
510T0008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem Medicaid |
$98.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Humana KY Medicaid |
$98.70
|
| Rate for Payer: Kentucky WC Medicaid |
$99.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
EST PT MID LEVEL 3(T
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem Medicaid |
$98.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Humana KY Medicaid |
$98.70
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$99.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
EST PT MID LEVEL 3(T
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
510T0008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
ESTRACE 0.01% VAG CRM (42.5GM)
|
Facility
|
IP
|
$22.44
|
|
|
Service Code
|
NDC 430375414
|
| Hospital Charge Code |
25000637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$17.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.50
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cigna Commercial |
$18.63
|
| Rate for Payer: First Health Commercial |
$21.32
|
| Rate for Payer: Humana Commercial |
$19.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.75
|
| Rate for Payer: Ohio Health Group HMO |
$16.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.48
|
| Rate for Payer: PHCS Commercial |
$21.54
|
| Rate for Payer: United Healthcare All Payer |
$19.75
|
|
|
ESTRACE 0.01% VAG CRM (42.5GM)
|
Facility
|
OP
|
$22.44
|
|
|
Service Code
|
NDC 430375414
|
| Hospital Charge Code |
25000637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$17.28
|
| Rate for Payer: Anthem Medicaid |
$7.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.50
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cigna Commercial |
$18.63
|
| Rate for Payer: First Health Commercial |
$21.32
|
| Rate for Payer: Humana Commercial |
$19.07
|
| Rate for Payer: Humana KY Medicaid |
$7.72
|
| Rate for Payer: Kentucky WC Medicaid |
$7.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.75
|
| Rate for Payer: Ohio Health Group HMO |
$16.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.48
|
| Rate for Payer: PHCS Commercial |
$21.54
|
| Rate for Payer: United Healthcare All Payer |
$19.75
|
|
|
ESTRACE (ESTRADIOL) 1 1MG/1TAB
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 555088602
|
| Hospital Charge Code |
25000636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
ESTRACE (ESTRADIOL) 1 1MG/1TAB
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 555088602
|
| Hospital Charge Code |
25000636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
ESTRADIOL (10MG)20 MG/ML MDV
|
Facility
|
IP
|
$98.21
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.46 |
| Max. Negotiated Rate |
$94.28 |
| Rate for Payer: Aetna Commercial |
$75.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.60
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cigna Commercial |
$81.51
|
| Rate for Payer: First Health Commercial |
$93.30
|
| Rate for Payer: Humana Commercial |
$83.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.42
|
| Rate for Payer: Ohio Health Group HMO |
$73.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.76
|
| Rate for Payer: PHCS Commercial |
$94.28
|
| Rate for Payer: United Healthcare All Payer |
$86.42
|
|
|
ESTRADIOL (10MG)20 MG/ML MDV
|
Facility
|
IP
|
$98.21
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
636T0222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.46 |
| Max. Negotiated Rate |
$94.28 |
| Rate for Payer: Aetna Commercial |
$75.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.60
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cigna Commercial |
$81.51
|
| Rate for Payer: First Health Commercial |
$93.30
|
| Rate for Payer: Humana Commercial |
$83.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.42
|
| Rate for Payer: Ohio Health Group HMO |
$73.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.76
|
| Rate for Payer: PHCS Commercial |
$94.28
|
| Rate for Payer: United Healthcare All Payer |
$86.42
|
|
|
ESTRADIOL (10MG)20 MG/ML MDV
|
Facility
|
OP
|
$98.21
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
636T0222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.46 |
| Max. Negotiated Rate |
$94.28 |
| Rate for Payer: Aetna Commercial |
$75.62
|
| Rate for Payer: Anthem Medicaid |
$33.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.60
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cigna Commercial |
$81.51
|
| Rate for Payer: First Health Commercial |
$93.30
|
| Rate for Payer: Humana Commercial |
$83.48
|
| Rate for Payer: Humana KY Medicaid |
$33.77
|
| Rate for Payer: Kentucky WC Medicaid |
$34.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.42
|
| Rate for Payer: Ohio Health Group HMO |
$73.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.76
|
| Rate for Payer: PHCS Commercial |
$94.28
|
| Rate for Payer: United Healthcare All Payer |
$86.42
|
|
|
ESTRADIOL (10MG)20 MG/ML MDV
|
Professional
|
Both
|
$98.21
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$58.93 |
| Rate for Payer: Aetna Commercial |
$15.42
|
| Rate for Payer: Ambetter Exchange |
$7.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.25
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.71
|
| Rate for Payer: Multiplan PHCS |
$58.93
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.02
|
| Rate for Payer: UHCCP Medicaid |
$34.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.71
|
|
|
ESTRADIOL (10MG)20 MG/ML MDV
|
Facility
|
OP
|
$98.21
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.46 |
| Max. Negotiated Rate |
$94.28 |
| Rate for Payer: Aetna Commercial |
$75.62
|
| Rate for Payer: Anthem Medicaid |
$33.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.60
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cigna Commercial |
$81.51
|
| Rate for Payer: First Health Commercial |
$93.30
|
| Rate for Payer: Humana Commercial |
$83.48
|
| Rate for Payer: Humana KY Medicaid |
$33.77
|
| Rate for Payer: Kentucky WC Medicaid |
$34.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.42
|
| Rate for Payer: Ohio Health Group HMO |
$73.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.76
|
| Rate for Payer: PHCS Commercial |
$94.28
|
| Rate for Payer: United Healthcare All Payer |
$86.42
|
|
|
ESTRADIOL 50MG PELLET
|
Facility
|
IP
|
$144.48
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna Commercial |
$111.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.69
|
| Rate for Payer: Cash Price |
$72.24
|
| Rate for Payer: Cigna Commercial |
$119.92
|
| Rate for Payer: First Health Commercial |
$137.26
|
| Rate for Payer: Humana Commercial |
$122.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.14
|
| Rate for Payer: Ohio Health Group HMO |
$108.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.69
|
| Rate for Payer: PHCS Commercial |
$138.70
|
| Rate for Payer: United Healthcare All Payer |
$127.14
|
|
|
ESTRADIOL 50MG PELLET
|
Facility
|
OP
|
$144.48
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
636T0228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna Commercial |
$111.25
|
| Rate for Payer: Anthem Medicaid |
$49.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.69
|
| Rate for Payer: Cash Price |
$72.24
|
| Rate for Payer: Cigna Commercial |
$119.92
|
| Rate for Payer: First Health Commercial |
$137.26
|
| Rate for Payer: Humana Commercial |
$122.81
|
| Rate for Payer: Humana KY Medicaid |
$49.69
|
| Rate for Payer: Kentucky WC Medicaid |
$50.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.14
|
| Rate for Payer: Ohio Health Group HMO |
$108.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.69
|
| Rate for Payer: PHCS Commercial |
$138.70
|
| Rate for Payer: United Healthcare All Payer |
$127.14
|
|
|
ESTRADIOL 50MG PELLET
|
Facility
|
OP
|
$144.48
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna Commercial |
$111.25
|
| Rate for Payer: Anthem Medicaid |
$49.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.69
|
| Rate for Payer: Cash Price |
$72.24
|
| Rate for Payer: Cigna Commercial |
$119.92
|
| Rate for Payer: First Health Commercial |
$137.26
|
| Rate for Payer: Humana Commercial |
$122.81
|
| Rate for Payer: Humana KY Medicaid |
$49.69
|
| Rate for Payer: Kentucky WC Medicaid |
$50.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.14
|
| Rate for Payer: Ohio Health Group HMO |
$108.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.69
|
| Rate for Payer: PHCS Commercial |
$138.70
|
| Rate for Payer: United Healthcare All Payer |
$127.14
|
|
