|
NaCl 0.9% IRRIGATION 1 L BAG
|
Facility
|
IP
|
$24.75
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
25004443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$23.76 |
| Rate for Payer: Aetna Commercial |
$19.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.30
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cigna Commercial |
$20.54
|
| Rate for Payer: First Health Commercial |
$23.51
|
| Rate for Payer: Humana Commercial |
$21.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.78
|
| Rate for Payer: Ohio Health Group HMO |
$18.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.67
|
| Rate for Payer: PHCS Commercial |
$23.76
|
| Rate for Payer: United Healthcare All Payer |
$21.78
|
|
|
NaCl 0.9% IRRIGATION 1 L BAG
|
Facility
|
OP
|
$24.75
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
25004443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$23.76 |
| Rate for Payer: Aetna Commercial |
$19.06
|
| Rate for Payer: Anthem Medicaid |
$8.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.30
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cigna Commercial |
$20.54
|
| Rate for Payer: First Health Commercial |
$23.51
|
| Rate for Payer: Humana Commercial |
$21.04
|
| Rate for Payer: Humana KY Medicaid |
$8.51
|
| Rate for Payer: Kentucky WC Medicaid |
$8.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.78
|
| Rate for Payer: Ohio Health Group HMO |
$18.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.67
|
| Rate for Payer: PHCS Commercial |
$23.76
|
| Rate for Payer: United Healthcare All Payer |
$21.78
|
|
|
NaCl 0.9% IRRIGATION 2 L BAG
|
Facility
|
OP
|
$81.98
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
25002789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.70 |
| Rate for Payer: Aetna Commercial |
$63.12
|
| Rate for Payer: Anthem Medicaid |
$28.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.94
|
| Rate for Payer: Cash Price |
$40.99
|
| Rate for Payer: Cigna Commercial |
$68.04
|
| Rate for Payer: First Health Commercial |
$77.88
|
| Rate for Payer: Humana Commercial |
$69.68
|
| Rate for Payer: Humana KY Medicaid |
$28.19
|
| Rate for Payer: Kentucky WC Medicaid |
$28.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.14
|
| Rate for Payer: Ohio Health Group HMO |
$61.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.41
|
| Rate for Payer: PHCS Commercial |
$78.70
|
| Rate for Payer: United Healthcare All Payer |
$72.14
|
|
|
NaCl 0.9% IRRIGATION 2 L BAG
|
Facility
|
IP
|
$81.98
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
25002789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.70 |
| Rate for Payer: Aetna Commercial |
$63.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.94
|
| Rate for Payer: Cash Price |
$40.99
|
| Rate for Payer: Cigna Commercial |
$68.04
|
| Rate for Payer: First Health Commercial |
$77.88
|
| Rate for Payer: Humana Commercial |
$69.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.14
|
| Rate for Payer: Ohio Health Group HMO |
$61.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.41
|
| Rate for Payer: PHCS Commercial |
$78.70
|
| Rate for Payer: United Healthcare All Payer |
$72.14
|
|
|
NACL 0.9% RESP. NEB (15ML)
|
Facility
|
IP
|
$4.99
|
|
|
Service Code
|
NDC 378698789
|
| Hospital Charge Code |
25001037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.89
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.14
|
| Rate for Payer: First Health Commercial |
$4.74
|
| Rate for Payer: Humana Commercial |
$4.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.39
|
| Rate for Payer: Ohio Health Group HMO |
$3.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Payer |
$4.39
|
|
|
NACL 0.9% RESP. NEB (15ML)
|
Facility
|
OP
|
$4.99
|
|
|
Service Code
|
NDC 378698789
|
| Hospital Charge Code |
25001037
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Anthem Medicaid |
$1.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.89
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.14
|
| Rate for Payer: First Health Commercial |
$4.74
|
| Rate for Payer: Humana Commercial |
$4.24
|
| Rate for Payer: Humana KY Medicaid |
$1.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.39
|
| Rate for Payer: Ohio Health Group HMO |
$3.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.55
|
| Rate for Payer: PHCS Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Payer |
$4.39
|
|
|
NaCl 3% 1mL (0.513 mEq/mL)
|
Facility
|
IP
|
$113.35
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25004133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$108.82 |
| Rate for Payer: Aetna Commercial |
$87.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.41
|
| Rate for Payer: Cash Price |
$56.67
|
| Rate for Payer: Cigna Commercial |
$94.08
|
| Rate for Payer: First Health Commercial |
$107.68
|
| Rate for Payer: Humana Commercial |
$96.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.75
|
| Rate for Payer: Ohio Health Group HMO |
$85.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.14
|
| Rate for Payer: PHCS Commercial |
$108.82
|
| Rate for Payer: United Healthcare All Payer |
$99.75
|
|
|
NaCl 3% 1mL (0.513 mEq/mL)
|
Facility
|
OP
|
$113.35
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25004133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$108.82 |
| Rate for Payer: Aetna Commercial |
$87.28
|
| Rate for Payer: Anthem Medicaid |
$38.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.41
|
| Rate for Payer: Cash Price |
$56.67
|
| Rate for Payer: Cigna Commercial |
$94.08
|
| Rate for Payer: First Health Commercial |
$107.68
|
| Rate for Payer: Humana Commercial |
$96.35
|
| Rate for Payer: Humana KY Medicaid |
$38.98
|
| Rate for Payer: Kentucky WC Medicaid |
$39.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.75
|
| Rate for Payer: Ohio Health Group HMO |
$85.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.14
|
| Rate for Payer: PHCS Commercial |
$108.82
|
| Rate for Payer: United Healthcare All Payer |
$99.75
|
|
|
NaCl 3% 1mL (3 mg/mL)
|
Facility
|
IP
|
$113.35
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25004134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$108.82 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.75
|
| Rate for Payer: Ohio Health Group HMO |
$85.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.14
|
| Rate for Payer: PHCS Commercial |
$108.82
|
| Rate for Payer: United Healthcare All Payer |
$99.75
|
| Rate for Payer: Aetna Commercial |
$87.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.41
|
| Rate for Payer: Cash Price |
$56.67
|
| Rate for Payer: Cigna Commercial |
$94.08
|
| Rate for Payer: First Health Commercial |
$107.68
|
| Rate for Payer: Humana Commercial |
$96.35
|
|
|
NaCl 3% 1mL (3 mg/mL)
|
Facility
|
OP
|
$113.35
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25004134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$108.82 |
| Rate for Payer: Aetna Commercial |
$87.28
|
| Rate for Payer: Anthem Medicaid |
$38.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.41
|
| Rate for Payer: Cash Price |
$56.67
|
| Rate for Payer: Cigna Commercial |
$94.08
|
| Rate for Payer: First Health Commercial |
$107.68
|
| Rate for Payer: Humana Commercial |
$96.35
|
| Rate for Payer: Humana KY Medicaid |
$38.98
|
| Rate for Payer: Kentucky WC Medicaid |
$39.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.75
|
| Rate for Payer: Ohio Health Group HMO |
$85.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.14
|
| Rate for Payer: PHCS Commercial |
$108.82
|
| Rate for Payer: United Healthcare All Payer |
$99.75
|
|
|
NAFCILLIN 1gm/54mL BAG (ANES)
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.58
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
NAFCILLIN 1gm/54mL BAG (ANES)
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem Medicaid |
$40.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Humana KY Medicaid |
$40.58
|
| Rate for Payer: Kentucky WC Medicaid |
$40.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.58
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
NAFCILLIN 2gm/58mL BAG (ANES)
|
Facility
|
IP
|
$129.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna Commercial |
$99.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.01
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cigna Commercial |
$107.48
|
| Rate for Payer: First Health Commercial |
$123.02
|
| Rate for Payer: Humana Commercial |
$110.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.96
|
| Rate for Payer: Ohio Health Group HMO |
$97.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.14
|
| Rate for Payer: PHCS Commercial |
$124.32
|
| Rate for Payer: United Healthcare All Payer |
$113.96
|
|
|
NAFCILLIN 2gm/58mL BAG (ANES)
|
Facility
|
OP
|
$129.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$124.32 |
| Rate for Payer: Aetna Commercial |
$99.72
|
| Rate for Payer: Anthem Medicaid |
$44.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.01
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cigna Commercial |
$107.48
|
| Rate for Payer: First Health Commercial |
$123.02
|
| Rate for Payer: Humana Commercial |
$110.08
|
| Rate for Payer: Humana KY Medicaid |
$44.54
|
| Rate for Payer: Kentucky WC Medicaid |
$44.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.96
|
| Rate for Payer: Ohio Health Group HMO |
$97.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.14
|
| Rate for Payer: PHCS Commercial |
$124.32
|
| Rate for Payer: United Healthcare All Payer |
$113.96
|
|
|
NAFCIL (NAFCILLIN SODI 2GM/8ML
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.62
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
NAFCIL (NAFCILLIN SODI 2GM/8ML
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$44.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.62
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$44.36
|
| Rate for Payer: Kentucky WC Medicaid |
$44.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
NAIL BED REPAIR
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
NAIL BED REPAIR
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
45000040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Humana KY Medicaid |
$255.17
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$257.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
NAIL DEBRIDEMENT 6 OR MORE
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
76100095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.73 |
| Max. Negotiated Rate |
$308.16 |
| Rate for Payer: Aetna Commercial |
$247.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.38
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$266.43
|
| Rate for Payer: First Health Commercial |
$304.95
|
| Rate for Payer: Humana Commercial |
$272.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$282.48
|
| Rate for Payer: Ohio Health Group HMO |
$240.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.51
|
| Rate for Payer: PHCS Commercial |
$308.16
|
| Rate for Payer: United Healthcare All Payer |
$282.48
|
|
|
NAIL DEBRIDEMENT 6 OR MORE
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
76100095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Aetna Commercial |
$44.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$14.91
|
| Rate for Payer: Anthem Medicaid |
$30.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$321.00
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$58.83
|
| Rate for Payer: Healthspan PPO |
$50.74
|
| Rate for Payer: Humana Medicaid |
$30.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$32.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.31
|
| Rate for Payer: Molina Healthcare Passport |
$30.70
|
| Rate for Payer: Multiplan PHCS |
$192.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$224.70
|
| Rate for Payer: UHCCP Medicaid |
$15.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.01
|
|
|
NAIL DEBRIDEMENT 6 OR MORE
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
76100095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.73 |
| Max. Negotiated Rate |
$308.16 |
| Rate for Payer: Aetna Commercial |
$247.17
|
| Rate for Payer: Anthem Medicaid |
$110.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$266.43
|
| Rate for Payer: First Health Commercial |
$304.95
|
| Rate for Payer: Humana Commercial |
$272.85
|
| Rate for Payer: Humana KY Medicaid |
$110.39
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$282.48
|
| Rate for Payer: Ohio Health Group HMO |
$240.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.51
|
| Rate for Payer: PHCS Commercial |
$308.16
|
| Rate for Payer: United Healthcare All Payer |
$282.48
|
|
|
NAIL DEBRIDEMENT 6 OR MORE(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
761P0095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$44.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$14.91
|
| Rate for Payer: Anthem Medicaid |
$30.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$58.83
|
| Rate for Payer: Healthspan PPO |
$50.74
|
| Rate for Payer: Humana Medicaid |
$30.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$32.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.31
|
| Rate for Payer: Molina Healthcare Passport |
$30.70
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$15.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.01
|
|
|
NAIL DEBRIDEMENT 6 OR MORE(T
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
761T0095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$188.16 |
| Rate for Payer: Aetna Commercial |
$150.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.88
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$162.68
|
| Rate for Payer: First Health Commercial |
$186.20
|
| Rate for Payer: Humana Commercial |
$166.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$160.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$172.48
|
| Rate for Payer: Ohio Health Group HMO |
$147.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.76
|
| Rate for Payer: PHCS Commercial |
$188.16
|
| Rate for Payer: United Healthcare All Payer |
$172.48
|
|
|
NAIL DEBRIDEMENT 6 OR MORE(T
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
761T0095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$188.16 |
| Rate for Payer: Aetna Commercial |
$150.92
|
| Rate for Payer: Anthem Medicaid |
$67.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cigna Commercial |
$162.68
|
| Rate for Payer: First Health Commercial |
$186.20
|
| Rate for Payer: Humana Commercial |
$166.60
|
| Rate for Payer: Humana KY Medicaid |
$67.40
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$68.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$160.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$144.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$172.48
|
| Rate for Payer: Ohio Health Group HMO |
$147.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.76
|
| Rate for Payer: PHCS Commercial |
$188.16
|
| Rate for Payer: United Healthcare All Payer |
$172.48
|
|
|
NAIL GUIDEWIRE BEADED 2.2M*98C
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
