|
014 THRUWAY WIRE 190CM LT
|
Facility
OP
|
$1,524.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$9,415.68 |
| Rate for Payer: Aetna Commercial |
$1,173.79
|
| Rate for Payer: Anthem Medicaid |
$524.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.03
|
| Rate for Payer: Cash Price |
$762.20
|
| Rate for Payer: Cigna Commercial |
$1,265.25
|
| Rate for Payer: First Health Commercial |
$1,448.18
|
| Rate for Payer: Humana Commercial |
$1,295.74
|
| Rate for Payer: Humana KY Medicaid |
$524.24
|
| Rate for Payer: Kentucky WC Medicaid |
$529.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,341.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.56
|
| Rate for Payer: PHCS Commercial |
$1,463.42
|
| Rate for Payer: United Healthcare All Payer |
$1,341.47
|
|
|
014 THRUWAY WIRE 190CM LT
|
Facility
IP
|
$1,524.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$9,415.68 |
| Rate for Payer: Aetna Commercial |
$1,173.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.03
|
| Rate for Payer: Cash Price |
$762.20
|
| Rate for Payer: Cigna Commercial |
$1,265.25
|
| Rate for Payer: First Health Commercial |
$1,448.18
|
| Rate for Payer: Humana Commercial |
$1,295.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,341.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.56
|
| Rate for Payer: PHCS Commercial |
$1,463.42
|
|
|
014 THRUWAY WIRE 300CM ST
|
Facility
OP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$9,415.68 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem Medicaid |
$614.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Humana KY Medicaid |
$614.72
|
| Rate for Payer: Kentucky WC Medicaid |
$620.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
014 THRUWAY WIRE 300CM ST
|
Facility
IP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$9,415.68 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
|
|
.035 260CM FIXED STRAIGHT
|
Facility
OP
|
$158.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$9,415.68 |
| Rate for Payer: Aetna Commercial |
$121.97
|
| Rate for Payer: Anthem Medicaid |
$54.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.55
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$131.47
|
| Rate for Payer: First Health Commercial |
$150.48
|
| Rate for Payer: Humana Commercial |
$134.64
|
| Rate for Payer: Humana KY Medicaid |
$54.47
|
| Rate for Payer: Kentucky WC Medicaid |
$55.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$129.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$55.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.39
|
| Rate for Payer: Ohio Health Group HMO |
$118.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.10
|
| Rate for Payer: PHCS Commercial |
$152.06
|
| Rate for Payer: United Healthcare All Payer |
$139.39
|
|
|
.035 260CM FIXED STRAIGHT
|
Facility
IP
|
$158.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$9,415.68 |
| Rate for Payer: Aetna Commercial |
$121.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.55
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$131.47
|
| Rate for Payer: First Health Commercial |
$150.48
|
| Rate for Payer: Humana Commercial |
$134.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$129.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.39
|
| Rate for Payer: Ohio Health Group HMO |
$118.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.10
|
| Rate for Payer: PHCS Commercial |
$152.06
|
|
|
.035 FIXED EXCH
|
Facility
OP
|
$803.18
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$9,415.68 |
| Rate for Payer: Aetna Commercial |
$618.45
|
| Rate for Payer: Anthem Medicaid |
$276.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$626.48
|
| Rate for Payer: Cash Price |
$401.59
|
| Rate for Payer: Cigna Commercial |
$666.64
|
| Rate for Payer: First Health Commercial |
$763.02
|
| Rate for Payer: Humana Commercial |
$682.70
|
| Rate for Payer: Humana KY Medicaid |
$276.21
|
| Rate for Payer: Kentucky WC Medicaid |
$279.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.80
|
| Rate for Payer: Ohio Health Group HMO |
$602.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.99
|
| Rate for Payer: PHCS Commercial |
$771.05
|
| Rate for Payer: United Healthcare All Payer |
$706.80
|
|
|
.035 FIXED EXCH
|
Facility
IP
|
$803.18
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$9,415.68 |
| Rate for Payer: Aetna Commercial |
$618.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$626.48
|
| Rate for Payer: Cash Price |
$401.59
|
| Rate for Payer: Cigna Commercial |
$666.64
|
| Rate for Payer: First Health Commercial |
$763.02
|
| Rate for Payer: Humana Commercial |
$682.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.80
|
| Rate for Payer: Ohio Health Group HMO |
$602.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.99
|
| Rate for Payer: PHCS Commercial |
$771.05
|
|
|
0.45% SODIUM CHLORIDE (RE 30ML
|
Facility
IP
|
$75.85
|
|
| Hospital Charge Code |
25002783
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$72.82 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.16
|
| Rate for Payer: Cash Price |
$37.92
|
| Rate for Payer: Cigna Commercial |
$62.96
|
| Rate for Payer: First Health Commercial |
$72.06
|
| Rate for Payer: Humana Commercial |
$64.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.75
|
| Rate for Payer: Ohio Health Group HMO |
$56.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.51
|
| Rate for Payer: PHCS Commercial |
$72.82
|
|
|
0.45% SODIUM CHLORIDE (RE 30ML
|
Facility
OP
|
$75.85
|
|
| Hospital Charge Code |
25002783
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$72.82 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: Anthem Medicaid |
$26.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.16
|
| Rate for Payer: Cash Price |
$37.92
|
| Rate for Payer: Cigna Commercial |
$62.96
|
| Rate for Payer: First Health Commercial |
$72.06
|
| Rate for Payer: Humana Commercial |
$64.47
|
| Rate for Payer: Humana KY Medicaid |
$26.08
|
| Rate for Payer: Kentucky WC Medicaid |
$26.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.75
|
| Rate for Payer: Ohio Health Group HMO |
$56.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.51
|
| Rate for Payer: PHCS Commercial |
$72.82
|
| Rate for Payer: United Healthcare All Payer |
$66.75
|
|
|
0.9% NACL EXCEL 250ML IV SOLN
|
Facility
IP
|
$64.87
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
25003658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$62.28 |
| Rate for Payer: Aetna Commercial |
$49.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.60
|
| Rate for Payer: Cash Price |
$32.44
|
| Rate for Payer: Cigna Commercial |
$53.84
|
| Rate for Payer: First Health Commercial |
$61.63
|
| Rate for Payer: Humana Commercial |
$55.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.09
|
| Rate for Payer: Ohio Health Group HMO |
$48.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.11
|
| Rate for Payer: PHCS Commercial |
$62.28
|
|
|
0.9% NACL EXCEL 250ML IV SOLN
|
Facility
OP
|
$64.87
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
25003658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$62.28 |
| Rate for Payer: Aetna Commercial |
$49.95
|
| Rate for Payer: Anthem Medicaid |
$22.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.60
|
| Rate for Payer: Cash Price |
$32.44
|
| Rate for Payer: Cigna Commercial |
$53.84
|
| Rate for Payer: First Health Commercial |
$61.63
|
| Rate for Payer: Humana Commercial |
$55.14
|
| Rate for Payer: Humana KY Medicaid |
$22.31
|
| Rate for Payer: Kentucky WC Medicaid |
$22.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.09
|
| Rate for Payer: Ohio Health Group HMO |
$48.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.11
|
| Rate for Payer: PHCS Commercial |
$62.28
|
| Rate for Payer: United Healthcare All Payer |
$57.09
|
|
|
0.9% NACL EXCEL 500ML IV SOLN
|
Facility
OP
|
$65.38
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
25003659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$62.76 |
| Rate for Payer: Aetna Commercial |
$50.34
|
| Rate for Payer: Anthem Medicaid |
$22.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.00
|
| Rate for Payer: Cash Price |
$32.69
|
| Rate for Payer: Cigna Commercial |
$54.27
|
| Rate for Payer: First Health Commercial |
$62.11
|
| Rate for Payer: Humana Commercial |
$55.57
|
| Rate for Payer: Humana KY Medicaid |
$22.48
|
| Rate for Payer: Kentucky WC Medicaid |
$22.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.53
|
| Rate for Payer: Ohio Health Group HMO |
$49.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.27
|
| Rate for Payer: PHCS Commercial |
$62.76
|
| Rate for Payer: United Healthcare All Payer |
$57.53
|
|
|
0.9% NACL EXCEL 500ML IV SOLN
|
Professional
|
$65.08
|
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.78 |
| Max. Negotiated Rate |
$65.08 |
| Rate for Payer: Buckeye Medicare Advantage |
$65.08
|
| Rate for Payer: Cash Price |
$32.54
|
| Rate for Payer: Multiplan PHCS |
$39.05
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.56
|
| Rate for Payer: UHCCP Medicaid |
$22.78
|
|
|
0.9% NACL EXCEL 500ML IV SOLN
|
Facility
OP
|
$65.08
|
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Aetna Commercial |
$50.11
|
| Rate for Payer: Anthem Medicaid |
$22.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.76
|
| Rate for Payer: Cash Price |
$32.54
|
| Rate for Payer: Cigna Commercial |
$54.02
|
| Rate for Payer: First Health Commercial |
$61.83
|
| Rate for Payer: Humana Commercial |
$55.32
|
| Rate for Payer: Humana KY Medicaid |
$22.38
|
| Rate for Payer: Kentucky WC Medicaid |
$22.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.27
|
| Rate for Payer: Ohio Health Group HMO |
$48.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.17
|
| Rate for Payer: PHCS Commercial |
$62.48
|
| Rate for Payer: United Healthcare All Payer |
$57.27
|
|
|
0.9% NACL EXCEL 500ML IV SOLN
|
Facility
OP
|
$65.08
|
|
| Hospital Charge Code |
636T0108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Aetna Commercial |
$50.11
|
| Rate for Payer: Anthem Medicaid |
$22.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.76
|
| Rate for Payer: Cash Price |
$32.54
|
| Rate for Payer: Cigna Commercial |
$54.02
|
| Rate for Payer: First Health Commercial |
$61.83
|
| Rate for Payer: Humana Commercial |
$55.32
|
| Rate for Payer: Humana KY Medicaid |
$22.38
|
| Rate for Payer: Kentucky WC Medicaid |
$22.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.27
|
| Rate for Payer: Ohio Health Group HMO |
$48.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.17
|
| Rate for Payer: PHCS Commercial |
$62.48
|
| Rate for Payer: United Healthcare All Payer |
$57.27
|
|
|
0.9% NACL EXCEL 500ML IV SOLN
|
Facility
IP
|
$65.08
|
|
| Hospital Charge Code |
636T0108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Aetna Commercial |
$50.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.76
|
| Rate for Payer: Cash Price |
$32.54
|
| Rate for Payer: Cigna Commercial |
$54.02
|
| Rate for Payer: First Health Commercial |
$61.83
|
| Rate for Payer: Humana Commercial |
$55.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.27
|
| Rate for Payer: Ohio Health Group HMO |
$48.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.17
|
| Rate for Payer: PHCS Commercial |
$62.48
|
|
|
0.9% NACL EXCEL 500ML IV SOLN
|
Facility
IP
|
$65.08
|
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$62.48 |
| Rate for Payer: Aetna Commercial |
$50.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.76
|
| Rate for Payer: Cash Price |
$32.54
|
| Rate for Payer: Cigna Commercial |
$54.02
|
| Rate for Payer: First Health Commercial |
$61.83
|
| Rate for Payer: Humana Commercial |
$55.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.27
|
| Rate for Payer: Ohio Health Group HMO |
$48.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.17
|
| Rate for Payer: PHCS Commercial |
$62.48
|
|
|
0.9% NACL EXCEL 500ML IV SOLN
|
Facility
IP
|
$65.38
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
25003659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$62.76 |
| Rate for Payer: Aetna Commercial |
$50.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.00
|
| Rate for Payer: Cash Price |
$32.69
|
| Rate for Payer: Cigna Commercial |
$54.27
|
| Rate for Payer: First Health Commercial |
$62.11
|
| Rate for Payer: Humana Commercial |
$55.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.53
|
| Rate for Payer: Ohio Health Group HMO |
$49.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.27
|
| Rate for Payer: PHCS Commercial |
$62.76
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
OP
|
$20.25
|
|
| Hospital Charge Code |
636T0157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$19.44 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Anthem Medicaid |
$6.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.80
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Cigna Commercial |
$16.81
|
| Rate for Payer: First Health Commercial |
$19.24
|
| Rate for Payer: Humana Commercial |
$17.21
|
| Rate for Payer: Humana KY Medicaid |
$6.96
|
| Rate for Payer: Kentucky WC Medicaid |
$7.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.82
|
| Rate for Payer: Ohio Health Group HMO |
$15.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.28
|
| Rate for Payer: PHCS Commercial |
$19.44
|
| Rate for Payer: United Healthcare All Payer |
$17.82
|
|
|
0.9% NaCl Irrigation 500mL
|
Professional
|
$20.25
|
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Buckeye Medicare Advantage |
$20.25
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Multiplan PHCS |
$12.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.18
|
| Rate for Payer: UHCCP Medicaid |
$7.09
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
IP
|
$20.25
|
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$19.44 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.80
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Cigna Commercial |
$16.81
|
| Rate for Payer: First Health Commercial |
$19.24
|
| Rate for Payer: Humana Commercial |
$17.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.82
|
| Rate for Payer: Ohio Health Group HMO |
$15.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.28
|
| Rate for Payer: PHCS Commercial |
$19.44
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
OP
|
$11.12
|
|
| Hospital Charge Code |
25004187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$19.44 |
| Rate for Payer: Aetna Commercial |
$8.56
|
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Anthem Medicaid |
$3.82
|
| Rate for Payer: Anthem Medicaid |
$6.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.67
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cigna Commercial |
$16.81
|
| Rate for Payer: Cigna Commercial |
$9.23
|
| Rate for Payer: First Health Commercial |
$19.24
|
| Rate for Payer: First Health Commercial |
$10.56
|
| Rate for Payer: Humana Commercial |
$17.21
|
| Rate for Payer: Humana Commercial |
$9.45
|
| Rate for Payer: Humana KY Medicaid |
$6.96
|
| Rate for Payer: Humana KY Medicaid |
$3.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.82
|
| Rate for Payer: Ohio Health Group HMO |
$8.34
|
| Rate for Payer: Ohio Health Group HMO |
$15.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.28
|
| Rate for Payer: PHCS Commercial |
$10.68
|
| Rate for Payer: PHCS Commercial |
$19.44
|
| Rate for Payer: United Healthcare All Payer |
$17.82
|
| Rate for Payer: United Healthcare All Payer |
$9.79
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
OP
|
$20.25
|
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$19.44 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Anthem Medicaid |
$6.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.80
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Cigna Commercial |
$16.81
|
| Rate for Payer: First Health Commercial |
$19.24
|
| Rate for Payer: Humana Commercial |
$17.21
|
| Rate for Payer: Humana KY Medicaid |
$6.96
|
| Rate for Payer: Kentucky WC Medicaid |
$7.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.82
|
| Rate for Payer: Ohio Health Group HMO |
$15.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.28
|
| Rate for Payer: PHCS Commercial |
$19.44
|
| Rate for Payer: United Healthcare All Payer |
$17.82
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
IP
|
$20.25
|
|
| Hospital Charge Code |
25004187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$19.44 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna Commercial |
$8.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.67
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Cigna Commercial |
$16.81
|
| Rate for Payer: Cigna Commercial |
$9.23
|
| Rate for Payer: First Health Commercial |
$10.56
|
| Rate for Payer: First Health Commercial |
$19.24
|
| Rate for Payer: Humana Commercial |
$17.21
|
| Rate for Payer: Humana Commercial |
$9.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.79
|
| Rate for Payer: Ohio Health Group HMO |
$15.19
|
| Rate for Payer: Ohio Health Group HMO |
$8.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.45
|
| Rate for Payer: PHCS Commercial |
$10.68
|
| Rate for Payer: PHCS Commercial |
$19.44
|
|
