|
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
|
| Rate for Payer: United Healthcare All Payer |
$57.27
|
|
|
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 |
$8.76 |
| 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 |
$50.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.89
|
| Rate for Payer: PHCS Commercial |
$64.68
|
| Rate for Payer: United Healthcare All Payer |
$59.29
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
NDC 990613803
|
| Hospital Charge Code |
25004187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.36
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: First Health Commercial |
$21.14
|
| Rate for Payer: Humana Commercial |
$18.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.58
|
| Rate for Payer: Ohio Health Group HMO |
$16.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
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
|
| Rate for Payer: United Healthcare All Payer |
$17.82
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
NDC 990613803
|
| Hospital Charge Code |
25004187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Humana Commercial |
$18.91
|
| Rate for Payer: Humana KY Medicaid |
$7.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.58
|
| Rate for Payer: Ohio Health Group HMO |
$16.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Anthem Medicaid |
$7.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.36
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: First Health Commercial |
$21.14
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
|
IP
|
$11.42
|
|
|
Service Code
|
NDC 264220110
|
| Hospital Charge Code |
25004187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Aetna Commercial |
$8.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.91
|
| Rate for Payer: Cash Price |
$5.71
|
| Rate for Payer: Cigna Commercial |
$9.48
|
| Rate for Payer: First Health Commercial |
$10.85
|
| Rate for Payer: Humana Commercial |
$9.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.05
|
| Rate for Payer: Ohio Health Group HMO |
$8.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.54
|
| Rate for Payer: PHCS Commercial |
$10.96
|
| Rate for Payer: United Healthcare All Payer |
$10.05
|
|
|
0.9% NaCl Irrigation 500mL
|
Professional
|
Both
|
$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
|
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
|
Facility
|
OP
|
$11.42
|
|
|
Service Code
|
NDC 264220110
|
| Hospital Charge Code |
25004187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Aetna Commercial |
$8.79
|
| Rate for Payer: Anthem Medicaid |
$3.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.91
|
| Rate for Payer: Cash Price |
$5.71
|
| Rate for Payer: Cigna Commercial |
$9.48
|
| Rate for Payer: First Health Commercial |
$10.85
|
| Rate for Payer: Humana Commercial |
$9.71
|
| Rate for Payer: Humana KY Medicaid |
$3.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.05
|
| Rate for Payer: Ohio Health Group HMO |
$8.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.54
|
| Rate for Payer: PHCS Commercial |
$10.96
|
| Rate for Payer: United Healthcare All Payer |
$10.05
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
|
IP
|
$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 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
|
| Rate for Payer: United Healthcare All Payer |
$17.82
|
|
|
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 (VISIV) 100ML IV SOL
|
Facility
|
OP
|
$69.25
|
|
|
Service Code
|
NDC 76297000122
|
| Hospital Charge Code |
25002784
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.00 |
| 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 |
$20.78
|
| 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 |
$13.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.47
|
| Rate for Payer: PHCS Commercial |
$66.48
|
| Rate for Payer: United Healthcare All Payer |
$60.94
|
|
|
0.9% NACL (VISIV) 100ML IV SOL
|
Facility
|
IP
|
$69.25
|
|
|
Service Code
|
NDC 76297000122
|
| Hospital Charge Code |
25002784
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$66.48 |
| 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 |
$20.78
|
| 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 |
$13.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.47
|
| Rate for Payer: PHCS Commercial |
$66.48
|
| Rate for Payer: United Healthcare All Payer |
$60.94
|
| 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
|
|
|
0.9% NSCL EXCEL 1000ML IVSOLN
|
Facility
|
OP
|
$91.73
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
25003660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$88.06 |
| Rate for Payer: Aetna Commercial |
$70.63
|
| Rate for Payer: Anthem Medicaid |
$31.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.55
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Cigna Commercial |
$76.14
|
| Rate for Payer: First Health Commercial |
$87.14
|
| Rate for Payer: Humana Commercial |
$77.97
|
| Rate for Payer: Humana KY Medicaid |
$31.55
|
| Rate for Payer: Kentucky WC Medicaid |
$31.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.72
|
| Rate for Payer: Ohio Health Group HMO |
$68.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.44
|
| Rate for Payer: PHCS Commercial |
$88.06
|
| Rate for Payer: United Healthcare All Payer |
$80.72
|
|
|
0.9% NSCL EXCEL 1000ML IVSOLN
|
Facility
|
IP
|
$91.73
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
25003660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$88.06 |
| Rate for Payer: Aetna Commercial |
$70.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.55
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Cigna Commercial |
$76.14
|
| Rate for Payer: First Health Commercial |
$87.14
|
| Rate for Payer: Humana Commercial |
$77.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.72
|
| Rate for Payer: Ohio Health Group HMO |
$68.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.44
|
| Rate for Payer: PHCS Commercial |
$88.06
|
| Rate for Payer: United Healthcare All Payer |
$80.72
|
|
|
100SCM SKSBH/F/DIGITS 1ST100
|
Facility
|
OP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.12 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem Medicaid |
$799.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Humana KY Medicaid |
$799.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$807.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$815.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.44
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
100SCM SKSBH/F/DIGITS 1ST100
|
Facility
|
IP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.12 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.44
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
|
|
10% DEXTRAN 40(LMD)/0.9% 500ML
|
Facility
|
OP
|
$129.19
|
|
|
Service Code
|
HCPCS J7100
|
| Hospital Charge Code |
25002790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$124.02 |
| Rate for Payer: Aetna Commercial |
$99.48
|
| Rate for Payer: Anthem Medicaid |
$44.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.77
|
| Rate for Payer: Cash Price |
$64.60
|
| Rate for Payer: Cigna Commercial |
$107.23
|
| Rate for Payer: First Health Commercial |
$122.73
|
| Rate for Payer: Humana Commercial |
$109.81
|
| Rate for Payer: Humana KY Medicaid |
$44.43
|
| Rate for Payer: Kentucky WC Medicaid |
$44.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.69
|
| Rate for Payer: Ohio Health Group HMO |
$96.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.05
|
| Rate for Payer: PHCS Commercial |
$124.02
|
| Rate for Payer: United Healthcare All Payer |
$113.69
|
|
|
10% DEXTRAN 40(LMD)/0.9% 500ML
|
Facility
|
IP
|
$129.19
|
|
|
Service Code
|
HCPCS J7100
|
| Hospital Charge Code |
25002790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$124.02 |
| Rate for Payer: Aetna Commercial |
$99.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.77
|
| Rate for Payer: Cash Price |
$64.60
|
| Rate for Payer: Cigna Commercial |
$107.23
|
| Rate for Payer: First Health Commercial |
$122.73
|
| Rate for Payer: Humana Commercial |
$109.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.69
|
| Rate for Payer: Ohio Health Group HMO |
$96.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.05
|
| Rate for Payer: PHCS Commercial |
$124.02
|
| Rate for Payer: United Healthcare All Payer |
$113.69
|
|
|
10 FR SHEATH
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
10 FR SHEATH
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
10% VITAMIN C 50 ML GBL
|
Professional
|
Both
|
$93.00
|
|
| Hospital Charge Code |
22200147
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$93.00
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Multiplan PHCS |
$55.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.10
|
| Rate for Payer: UHCCP Medicaid |
$32.55
|
|
|
11 FR SHEATH
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
11 FR SHEATH
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
11 LNG REV POL+20 L IMPLT STEM
|
Facility
|
OP
|
$27,879.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,624.34 |
| Max. Negotiated Rate |
$26,764.32 |
| Rate for Payer: Aetna Commercial |
$21,467.22
|
| Rate for Payer: Anthem Medicaid |
$9,587.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Humana KY Medicaid |
$9,587.76
|
| Rate for Payer: Kentucky WC Medicaid |
$9,685.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,780.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
