|
014 THRUWAY WIRE 190CM LT
|
Facility
|
IP
|
$1,497.92
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.38 |
| Max. Negotiated Rate |
$1,438.00 |
| Rate for Payer: Aetna Commercial |
$1,153.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,168.38
|
| Rate for Payer: Cash Price |
$748.96
|
| Rate for Payer: Cigna Commercial |
$1,243.27
|
| Rate for Payer: First Health Commercial |
$1,423.02
|
| Rate for Payer: Humana Commercial |
$1,273.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,228.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,105.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$449.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,318.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,123.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,198.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,303.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,033.56
|
| Rate for Payer: PHCS Commercial |
$1,438.00
|
| Rate for Payer: United Healthcare All Payer |
$1,318.17
|
|
|
014 THRUWAY WIRE 190CM LT
|
Facility
|
OP
|
$1,497.92
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$449.38 |
| Max. Negotiated Rate |
$1,438.00 |
| Rate for Payer: Aetna Commercial |
$1,153.40
|
| Rate for Payer: Anthem Medicaid |
$515.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,168.38
|
| Rate for Payer: Cash Price |
$748.96
|
| Rate for Payer: Cigna Commercial |
$1,243.27
|
| Rate for Payer: First Health Commercial |
$1,423.02
|
| Rate for Payer: Humana Commercial |
$1,273.23
|
| Rate for Payer: Humana KY Medicaid |
$515.13
|
| Rate for Payer: Kentucky WC Medicaid |
$520.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,228.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,105.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$449.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$525.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,318.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,123.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,198.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,303.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,033.56
|
| Rate for Payer: PHCS Commercial |
$1,438.00
|
| Rate for Payer: United Healthcare All Payer |
$1,318.17
|
|
|
014 THRUWAY WIRE 300CM ST
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Kentucky WC Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
014 THRUWAY WIRE 300CM ST
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
.035 260CM FIXED STRAIGHT
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.36
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.78
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
|
.035 260CM FIXED STRAIGHT
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem Medicaid |
$55.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.36
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| Rate for Payer: Humana KY Medicaid |
$55.71
|
| Rate for Payer: Kentucky WC Medicaid |
$56.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.78
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
|
.035 FIXED EXCH
|
Facility
|
IP
|
$825.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.72 |
| Max. Negotiated Rate |
$792.72 |
| Rate for Payer: Aetna Commercial |
$635.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$644.09
|
| Rate for Payer: Cash Price |
$412.88
|
| Rate for Payer: Cigna Commercial |
$685.37
|
| Rate for Payer: First Health Commercial |
$784.46
|
| Rate for Payer: Humana Commercial |
$701.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$677.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$609.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.66
|
| Rate for Payer: Ohio Health Group HMO |
$619.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.77
|
| Rate for Payer: PHCS Commercial |
$792.72
|
| Rate for Payer: United Healthcare All Payer |
$726.66
|
|
|
.035 FIXED EXCH
|
Facility
|
OP
|
$825.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.72 |
| Max. Negotiated Rate |
$792.72 |
| Rate for Payer: Aetna Commercial |
$635.83
|
| Rate for Payer: Anthem Medicaid |
$283.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$644.09
|
| Rate for Payer: Cash Price |
$412.88
|
| Rate for Payer: Cigna Commercial |
$685.37
|
| Rate for Payer: First Health Commercial |
$784.46
|
| Rate for Payer: Humana Commercial |
$701.89
|
| Rate for Payer: Humana KY Medicaid |
$283.98
|
| Rate for Payer: Kentucky WC Medicaid |
$286.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$677.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$609.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.66
|
| Rate for Payer: Ohio Health Group HMO |
$619.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.77
|
| Rate for Payer: PHCS Commercial |
$792.72
|
| Rate for Payer: United Healthcare All Payer |
$726.66
|
|
|
0.45% NACL (LVP) 100ML
|
Facility
|
OP
|
$79.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002778
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$61.36
|
| Rate for Payer: Anthem Medicaid |
$27.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.16
|
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Cigna Commercial |
$66.14
|
| Rate for Payer: First Health Commercial |
$75.71
|
| Rate for Payer: Humana Commercial |
$67.74
|
| Rate for Payer: Humana KY Medicaid |
$27.41
|
| Rate for Payer: Kentucky WC Medicaid |
$27.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.13
|
| Rate for Payer: Ohio Health Group HMO |
$59.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.99
|
| Rate for Payer: PHCS Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Payer |
$70.13
|
|
|
0.45% NACL (LVP) 100ML
|
Facility
|
IP
|
$79.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002778
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$61.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.16
|
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Cigna Commercial |
$66.14
|
| Rate for Payer: First Health Commercial |
$75.71
|
| Rate for Payer: Humana Commercial |
$67.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.13
|
| Rate for Payer: Ohio Health Group HMO |
$59.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.99
|
| Rate for Payer: PHCS Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Payer |
$70.13
|
|
|
0.45% NACL (LVP) 250ML
|
Facility
|
IP
|
$69.25
|
|
|
Service Code
|
NDC 990798502
|
| Hospital Charge Code |
25002779
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$20.77 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$53.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.02
|
| Rate for Payer: Cash Price |
$34.62
|
| Rate for Payer: Cigna Commercial |
$57.48
|
| Rate for Payer: First Health Commercial |
$65.79
|
| Rate for Payer: Humana Commercial |
$58.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.94
|
| Rate for Payer: Ohio Health Group HMO |
$51.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.78
|
| Rate for Payer: PHCS Commercial |
$66.48
|
| Rate for Payer: United Healthcare All Payer |
$60.94
|
|
|
0.45% NACL (LVP) 250ML
|
Facility
|
OP
|
$69.25
|
|
|
Service Code
|
NDC 990798502
|
| Hospital Charge Code |
25002779
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$20.77 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$53.32
|
| Rate for Payer: Anthem Medicaid |
$23.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.02
|
| Rate for Payer: Cash Price |
$34.62
|
| Rate for Payer: Cigna Commercial |
$57.48
|
| Rate for Payer: First Health Commercial |
$65.79
|
| Rate for Payer: Humana Commercial |
$58.86
|
| Rate for Payer: Humana KY Medicaid |
$23.82
|
| Rate for Payer: Kentucky WC Medicaid |
$24.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.94
|
| Rate for Payer: Ohio Health Group HMO |
$51.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.78
|
| Rate for Payer: PHCS Commercial |
$66.48
|
| Rate for Payer: United Healthcare All Payer |
$60.94
|
|
|
0.45% SODIUM CHLORIDE 1000ML
|
Facility
|
OP
|
$95.06
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002782
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$28.52 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna Commercial |
$73.20
|
| Rate for Payer: Anthem Medicaid |
$32.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.15
|
| Rate for Payer: Cash Price |
$47.53
|
| Rate for Payer: Cigna Commercial |
$78.90
|
| Rate for Payer: First Health Commercial |
$90.31
|
| Rate for Payer: Humana Commercial |
$80.80
|
| Rate for Payer: Humana KY Medicaid |
$32.69
|
| Rate for Payer: Kentucky WC Medicaid |
$33.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.65
|
| Rate for Payer: Ohio Health Group HMO |
$71.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.59
|
| Rate for Payer: PHCS Commercial |
$91.26
|
| Rate for Payer: United Healthcare All Payer |
$83.65
|
|
|
0.45% SODIUM CHLORIDE 1000ML
|
Facility
|
IP
|
$95.06
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002782
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$28.52 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna Commercial |
$73.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.15
|
| Rate for Payer: Cash Price |
$47.53
|
| Rate for Payer: Cigna Commercial |
$78.90
|
| Rate for Payer: First Health Commercial |
$90.31
|
| Rate for Payer: Humana Commercial |
$80.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.65
|
| Rate for Payer: Ohio Health Group HMO |
$71.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.59
|
| Rate for Payer: PHCS Commercial |
$91.26
|
| Rate for Payer: United Healthcare All Payer |
$83.65
|
|
|
0.45% SODIUM CHLORIDE 500ML
|
Facility
|
OP
|
$99.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002781
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$95.52 |
| Rate for Payer: Aetna Commercial |
$76.61
|
| Rate for Payer: Anthem Medicaid |
$34.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.61
|
| Rate for Payer: Cash Price |
$49.75
|
| Rate for Payer: Cigna Commercial |
$82.58
|
| Rate for Payer: First Health Commercial |
$94.53
|
| Rate for Payer: Humana Commercial |
$84.58
|
| Rate for Payer: Humana KY Medicaid |
$34.22
|
| Rate for Payer: Kentucky WC Medicaid |
$34.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.56
|
| Rate for Payer: Ohio Health Group HMO |
$74.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.66
|
| Rate for Payer: PHCS Commercial |
$95.52
|
| Rate for Payer: United Healthcare All Payer |
$87.56
|
|
|
0.45% SODIUM CHLORIDE 500ML
|
Facility
|
IP
|
$99.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002781
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$95.52 |
| Rate for Payer: Aetna Commercial |
$76.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.61
|
| Rate for Payer: Cash Price |
$49.75
|
| Rate for Payer: Cigna Commercial |
$82.58
|
| Rate for Payer: First Health Commercial |
$94.53
|
| Rate for Payer: Humana Commercial |
$84.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$87.56
|
| Rate for Payer: Ohio Health Group HMO |
$74.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.66
|
| Rate for Payer: PHCS Commercial |
$95.52
|
| Rate for Payer: United Healthcare All Payer |
$87.56
|
|
|
0.45% SODIUM CHLORIDE (RE 30ML
|
Facility
|
IP
|
$113.09
|
|
|
Service Code
|
NDC 990773036
|
| Hospital Charge Code |
25002783
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$108.57 |
| Rate for Payer: Aetna Commercial |
$87.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.21
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cigna Commercial |
$93.86
|
| Rate for Payer: First Health Commercial |
$107.44
|
| Rate for Payer: Humana Commercial |
$96.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.52
|
| Rate for Payer: Ohio Health Group HMO |
$84.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.03
|
| Rate for Payer: PHCS Commercial |
$108.57
|
| Rate for Payer: United Healthcare All Payer |
$99.52
|
|
|
0.45% SODIUM CHLORIDE (RE 30ML
|
Facility
|
OP
|
$113.09
|
|
|
Service Code
|
NDC 990773036
|
| Hospital Charge Code |
25002783
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$108.57 |
| Rate for Payer: Aetna Commercial |
$87.08
|
| Rate for Payer: Anthem Medicaid |
$38.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.21
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cigna Commercial |
$93.86
|
| Rate for Payer: First Health Commercial |
$107.44
|
| Rate for Payer: Humana Commercial |
$96.13
|
| Rate for Payer: Humana KY Medicaid |
$38.89
|
| Rate for Payer: Kentucky WC Medicaid |
$39.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.52
|
| Rate for Payer: Ohio Health Group HMO |
$84.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.03
|
| Rate for Payer: PHCS Commercial |
$108.57
|
| Rate for Payer: United Healthcare All Payer |
$99.52
|
|
|
0.9% NACL EXCEL 250ML IV SOLN
|
Facility
|
IP
|
$66.87
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
25003658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$64.20 |
| Rate for Payer: Aetna Commercial |
$51.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.16
|
| Rate for Payer: Cash Price |
$33.44
|
| Rate for Payer: Cigna Commercial |
$55.50
|
| Rate for Payer: First Health Commercial |
$63.53
|
| Rate for Payer: Humana Commercial |
$56.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.85
|
| Rate for Payer: Ohio Health Group HMO |
$50.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.14
|
| Rate for Payer: PHCS Commercial |
$64.20
|
| Rate for Payer: United Healthcare All Payer |
$58.85
|
|
|
0.9% NACL EXCEL 250ML IV SOLN
|
Facility
|
OP
|
$66.87
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
25003658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$64.20 |
| Rate for Payer: Aetna Commercial |
$51.49
|
| Rate for Payer: Anthem Medicaid |
$23.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.16
|
| Rate for Payer: Cash Price |
$33.44
|
| Rate for Payer: Cigna Commercial |
$55.50
|
| Rate for Payer: First Health Commercial |
$63.53
|
| Rate for Payer: Humana Commercial |
$56.84
|
| Rate for Payer: Humana KY Medicaid |
$23.00
|
| Rate for Payer: Kentucky WC Medicaid |
$23.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.85
|
| Rate for Payer: Ohio Health Group HMO |
$50.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.14
|
| Rate for Payer: PHCS Commercial |
$64.20
|
| Rate for Payer: United Healthcare All Payer |
$58.85
|
|
|
0.9% NACL EXCEL 500ML IV SOLN
|
Facility
|
IP
|
$67.38
|
|
| Hospital Charge Code |
636T0108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$64.68 |
| Rate for Payer: Aetna Commercial |
$51.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.56
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: Cigna Commercial |
$55.93
|
| Rate for Payer: First Health Commercial |
$64.01
|
| Rate for Payer: Humana Commercial |
$57.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.29
|
| Rate for Payer: Ohio Health Group HMO |
$50.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.49
|
| Rate for Payer: PHCS Commercial |
$64.68
|
| Rate for Payer: United Healthcare All Payer |
$59.29
|
|
|
0.9% NACL EXCEL 500ML IV SOLN
|
Facility
|
IP
|
$67.38
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
25003659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$64.68 |
| Rate for Payer: Aetna Commercial |
$51.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.56
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: Cigna Commercial |
$55.93
|
| Rate for Payer: First Health Commercial |
$64.01
|
| Rate for Payer: Humana Commercial |
$57.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.29
|
| Rate for Payer: Ohio Health Group HMO |
$50.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.49
|
| Rate for Payer: PHCS Commercial |
$64.68
|
| Rate for Payer: United Healthcare All Payer |
$59.29
|
|
|
0.9% NACL EXCEL 500ML IV SOLN
|
Facility
|
IP
|
$67.38
|
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$64.68 |
| Rate for Payer: Aetna Commercial |
$51.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.56
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: Cigna Commercial |
$55.93
|
| Rate for Payer: First Health Commercial |
$64.01
|
| Rate for Payer: Humana Commercial |
$57.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.29
|
| Rate for Payer: Ohio Health Group HMO |
$50.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.49
|
| Rate for Payer: PHCS Commercial |
$64.68
|
| Rate for Payer: United Healthcare All Payer |
$59.29
|
|
|
0.9% NACL EXCEL 500ML IV SOLN
|
Facility
|
OP
|
$67.38
|
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$64.68 |
| Rate for Payer: Aetna Commercial |
$51.88
|
| Rate for Payer: Anthem Medicaid |
$23.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.56
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: Cigna Commercial |
$55.93
|
| Rate for Payer: First Health Commercial |
$64.01
|
| Rate for Payer: Humana Commercial |
$57.27
|
| Rate for Payer: Humana KY Medicaid |
$23.17
|
| Rate for Payer: Kentucky WC Medicaid |
$23.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.29
|
| Rate for Payer: Ohio Health Group HMO |
$50.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.49
|
| Rate for Payer: PHCS Commercial |
$64.68
|
| Rate for Payer: United Healthcare All Payer |
$59.29
|
|
|
0.9% NACL EXCEL 500ML IV SOLN
|
Facility
|
OP
|
$67.38
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
25003659
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$64.68 |
| Rate for Payer: Aetna Commercial |
$51.88
|
| Rate for Payer: Anthem Medicaid |
$23.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.56
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: Cigna Commercial |
$55.93
|
| Rate for Payer: First Health Commercial |
$64.01
|
| Rate for Payer: Humana Commercial |
$57.27
|
| Rate for Payer: Humana KY Medicaid |
$23.17
|
| Rate for Payer: Kentucky WC Medicaid |
$23.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.29
|
| Rate for Payer: Ohio Health Group HMO |
$50.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.49
|
| Rate for Payer: PHCS Commercial |
$64.68
|
| Rate for Payer: United Healthcare All Payer |
$59.29
|
|
