|
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 |
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 Irrigation 500mL
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
NDC 990613803
|
| Hospital Charge Code |
25004187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$21.36 |
| 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
|
| 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 |
$18.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.67
|
| 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 |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.35
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
|
IP
|
$11.71
|
|
|
Service Code
|
NDC 264220110
|
| Hospital Charge Code |
25004187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.24 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.13
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna Commercial |
$9.72
|
| Rate for Payer: First Health Commercial |
$11.12
|
| Rate for Payer: Humana Commercial |
$9.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.30
|
| Rate for Payer: Ohio Health Group HMO |
$8.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.08
|
| Rate for Payer: PHCS Commercial |
$11.24
|
| Rate for Payer: United Healthcare All Payer |
$10.30
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
|
OP
|
$11.71
|
|
|
Service Code
|
NDC 264220110
|
| Hospital Charge Code |
25004187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.24 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Anthem Medicaid |
$4.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.13
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna Commercial |
$9.72
|
| Rate for Payer: First Health Commercial |
$11.12
|
| Rate for Payer: Humana Commercial |
$9.95
|
| Rate for Payer: Humana KY Medicaid |
$4.03
|
| Rate for Payer: Kentucky WC Medicaid |
$4.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.30
|
| Rate for Payer: Ohio Health Group HMO |
$8.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.08
|
| Rate for Payer: PHCS Commercial |
$11.24
|
| Rate for Payer: United Healthcare All Payer |
$10.30
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
|
OP
|
$11.71
|
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.24 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Anthem Medicaid |
$4.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.13
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna Commercial |
$9.72
|
| Rate for Payer: First Health Commercial |
$11.12
|
| Rate for Payer: Humana Commercial |
$9.95
|
| Rate for Payer: Humana KY Medicaid |
$4.03
|
| Rate for Payer: Kentucky WC Medicaid |
$4.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.30
|
| Rate for Payer: Ohio Health Group HMO |
$8.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.08
|
| Rate for Payer: PHCS Commercial |
$11.24
|
| Rate for Payer: United Healthcare All Payer |
$10.30
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
NDC 990613803
|
| Hospital Charge Code |
25004187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.67 |
| 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 |
$18.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.67
|
| 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 |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.35
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
|
OP
|
$11.71
|
|
| Hospital Charge Code |
636T0157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.24 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Anthem Medicaid |
$4.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.13
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna Commercial |
$9.72
|
| Rate for Payer: First Health Commercial |
$11.12
|
| Rate for Payer: Humana Commercial |
$9.95
|
| Rate for Payer: Humana KY Medicaid |
$4.03
|
| Rate for Payer: Kentucky WC Medicaid |
$4.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.30
|
| Rate for Payer: Ohio Health Group HMO |
$8.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.08
|
| Rate for Payer: PHCS Commercial |
$11.24
|
| Rate for Payer: United Healthcare All Payer |
$10.30
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
|
IP
|
$11.71
|
|
| Hospital Charge Code |
636T0157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.24 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.13
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna Commercial |
$9.72
|
| Rate for Payer: First Health Commercial |
$11.12
|
| Rate for Payer: Humana Commercial |
$9.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.30
|
| Rate for Payer: Ohio Health Group HMO |
$8.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.08
|
| Rate for Payer: PHCS Commercial |
$11.24
|
| Rate for Payer: United Healthcare All Payer |
$10.30
|
|
|
0.9% NaCl Irrigation 500mL
|
Professional
|
Both
|
$11.71
|
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$8.20 |
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Multiplan PHCS |
$7.03
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.20
|
| Rate for Payer: UHCCP Medicaid |
$4.10
|
|
|
0.9% NaCl Irrigation 500mL
|
Facility
|
IP
|
$11.71
|
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.24 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.13
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna Commercial |
$9.72
|
| Rate for Payer: First Health Commercial |
$11.12
|
| Rate for Payer: Humana Commercial |
$9.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.30
|
| Rate for Payer: Ohio Health Group HMO |
$8.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.08
|
| Rate for Payer: PHCS Commercial |
$11.24
|
| Rate for Payer: United Healthcare All Payer |
$10.30
|
|
|
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 |
$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
|
|
|
0.9% NACL (VISIV) 100ML IV SOL
|
Facility
|
OP
|
$69.25
|
|
|
Service Code
|
NDC 76297000122
|
| Hospital Charge Code |
25002784
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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
|
|
|
0.9% NSCL EXCEL 1000ML IVSOLN
|
Facility
|
OP
|
$91.73
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
25003660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.52 |
| 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 |
$73.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.29
|
| 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 |
$27.52 |
| 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 |
$73.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.29
|
| 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 |
$799.22 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem Medicaid |
$799.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| 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 |
$1,690.17
|
| 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 |
$2,028.20
|
| 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 |
$1,859.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.56
|
| 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 |
$697.20 |
| Max. Negotiated Rate |
$2,231.04 |
| 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 |
$1,859.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.56
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
10% DEXTRAN 40(LMD)/0.9% 500ML
|
Facility
|
IP
|
$177.40
|
|
|
Service Code
|
HCPCS J7100
|
| Hospital Charge Code |
25002790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.22 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Aetna Commercial |
$136.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.37
|
| Rate for Payer: Cash Price |
$88.70
|
| Rate for Payer: Cigna Commercial |
$147.24
|
| Rate for Payer: First Health Commercial |
$168.53
|
| Rate for Payer: Humana Commercial |
$150.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$130.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$156.11
|
| Rate for Payer: Ohio Health Group HMO |
$133.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.41
|
| Rate for Payer: PHCS Commercial |
$170.30
|
| Rate for Payer: United Healthcare All Payer |
$156.11
|
|
|
10% DEXTRAN 40(LMD)/0.9% 500ML
|
Facility
|
OP
|
$177.40
|
|
|
Service Code
|
HCPCS J7100
|
| Hospital Charge Code |
25002790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.22 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Aetna Commercial |
$136.60
|
| Rate for Payer: Anthem Medicaid |
$61.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.37
|
| Rate for Payer: Cash Price |
$88.70
|
| Rate for Payer: Cigna Commercial |
$147.24
|
| Rate for Payer: First Health Commercial |
$168.53
|
| Rate for Payer: Humana Commercial |
$150.79
|
| Rate for Payer: Humana KY Medicaid |
$61.01
|
| Rate for Payer: Kentucky WC Medicaid |
$61.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$130.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$156.11
|
| Rate for Payer: Ohio Health Group HMO |
$133.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.41
|
| Rate for Payer: PHCS Commercial |
$170.30
|
| Rate for Payer: United Healthcare All Payer |
$156.11
|
|
|
10 FR SHEATH
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
10% VITAMIN C 50 ML GBL
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
22200147
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
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 |
$65.10 |
| 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
|
|
|
10% VITAMIN C 50 ML GBL
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
22200147
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$31.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$31.98
|
| Rate for Payer: Kentucky WC Medicaid |
$32.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
11 FR SHEATH
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
