|
POST TAPER HUM HEAD 13.7*31 CE
|
Facility
|
OP
|
$4,797.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.61 |
| Max. Negotiated Rate |
$4,605.12 |
| Rate for Payer: Aetna Commercial |
$3,693.69
|
| Rate for Payer: Anthem Medicaid |
$1,649.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,741.66
|
| Rate for Payer: Cash Price |
$2,398.50
|
| Rate for Payer: Cigna Commercial |
$3,981.51
|
| Rate for Payer: First Health Commercial |
$4,557.15
|
| Rate for Payer: Humana Commercial |
$4,077.45
|
| Rate for Payer: Humana KY Medicaid |
$1,649.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,666.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,682.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.07
|
| Rate for Payer: PHCS Commercial |
$4,605.12
|
| Rate for Payer: United Healthcare All Payer |
$4,221.36
|
|
|
POST TAPER HUM HEAD 13.7*31 CE
|
Facility
|
IP
|
$4,797.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.61 |
| Max. Negotiated Rate |
$4,605.12 |
| Rate for Payer: Aetna Commercial |
$3,693.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,741.66
|
| Rate for Payer: Cash Price |
$2,398.50
|
| Rate for Payer: Cigna Commercial |
$3,981.51
|
| Rate for Payer: First Health Commercial |
$4,557.15
|
| Rate for Payer: Humana Commercial |
$4,077.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.07
|
| Rate for Payer: PHCS Commercial |
$4,605.12
|
| Rate for Payer: United Healthcare All Payer |
$4,221.36
|
|
|
POST VASECTOMY SEMEN ANALYSIS
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 89321
|
| Hospital Charge Code |
30001550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: Aetna Commercial |
$75.46
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$81.34
|
| Rate for Payer: First Health Commercial |
$93.10
|
| Rate for Payer: Humana Commercial |
$83.30
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.24
|
| Rate for Payer: Ohio Health Group HMO |
$73.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.38
|
| Rate for Payer: PHCS Commercial |
$94.08
|
| Rate for Payer: United Healthcare All Payer |
$86.24
|
|
|
POST VASECTOMY SEMEN ANALYSIS
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 89321
|
| Hospital Charge Code |
30001550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: Aetna Commercial |
$75.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.69
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$81.34
|
| Rate for Payer: First Health Commercial |
$93.10
|
| Rate for Payer: Humana Commercial |
$83.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.24
|
| Rate for Payer: Ohio Health Group HMO |
$73.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.38
|
| Rate for Payer: PHCS Commercial |
$94.08
|
| Rate for Payer: United Healthcare All Payer |
$86.24
|
|
|
POTASS CHL 2mEq (20mEq/50mL)PB
|
Facility
|
OP
|
$79.80
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25004099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$76.61 |
| Rate for Payer: Aetna Commercial |
$61.45
|
| Rate for Payer: Anthem Medicaid |
$27.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.24
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$66.23
|
| Rate for Payer: First Health Commercial |
$75.81
|
| Rate for Payer: Humana Commercial |
$67.83
|
| Rate for Payer: Humana KY Medicaid |
$27.44
|
| Rate for Payer: Kentucky WC Medicaid |
$27.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.22
|
| Rate for Payer: Ohio Health Group HMO |
$59.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.74
|
| Rate for Payer: PHCS Commercial |
$76.61
|
| Rate for Payer: United Healthcare All Payer |
$70.22
|
|
|
POTASS CHL 2mEq (20mEq/50mL)PB
|
Facility
|
IP
|
$79.80
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25004099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$76.61 |
| Rate for Payer: Aetna Commercial |
$61.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.24
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$66.23
|
| Rate for Payer: First Health Commercial |
$75.81
|
| Rate for Payer: Humana Commercial |
$67.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.22
|
| Rate for Payer: Ohio Health Group HMO |
$59.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.74
|
| Rate for Payer: PHCS Commercial |
$76.61
|
| Rate for Payer: United Healthcare All Payer |
$70.22
|
|
|
POTASSIUM ACETATE 40MEQ/20ML
|
Facility
|
OP
|
$79.80
|
|
|
Service Code
|
NDC 409818301
|
| Hospital Charge Code |
25003365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$76.61 |
| Rate for Payer: Aetna Commercial |
$61.45
|
| Rate for Payer: Anthem Medicaid |
$27.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.24
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$66.23
|
| Rate for Payer: First Health Commercial |
$75.81
|
| Rate for Payer: Humana Commercial |
$67.83
|
| Rate for Payer: Humana KY Medicaid |
$27.44
|
| Rate for Payer: Kentucky WC Medicaid |
$27.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.22
|
| Rate for Payer: Ohio Health Group HMO |
$59.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.74
|
| Rate for Payer: PHCS Commercial |
$76.61
|
| Rate for Payer: United Healthcare All Payer |
$70.22
|
|
|
POTASSIUM ACETATE 40MEQ/20ML
|
Facility
|
IP
|
$79.80
|
|
|
Service Code
|
NDC 409818301
|
| Hospital Charge Code |
25003365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$76.61 |
| Rate for Payer: Aetna Commercial |
$61.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.24
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$66.23
|
| Rate for Payer: First Health Commercial |
$75.81
|
| Rate for Payer: Humana Commercial |
$67.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.22
|
| Rate for Payer: Ohio Health Group HMO |
$59.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.74
|
| Rate for Payer: PHCS Commercial |
$76.61
|
| Rate for Payer: United Healthcare All Payer |
$70.22
|
|
|
POTASSIUM ALUM 10gm SDV
|
Facility
|
OP
|
$1,658.67
|
|
|
Service Code
|
NDC 24357030030
|
| Hospital Charge Code |
25004417
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$215.63 |
| Max. Negotiated Rate |
$1,592.32 |
| Rate for Payer: Aetna Commercial |
$1,277.18
|
| Rate for Payer: Anthem Medicaid |
$570.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,293.76
|
| Rate for Payer: Cash Price |
$829.34
|
| Rate for Payer: Cigna Commercial |
$1,376.70
|
| Rate for Payer: First Health Commercial |
$1,575.74
|
| Rate for Payer: Humana Commercial |
$1,409.87
|
| Rate for Payer: Humana KY Medicaid |
$570.42
|
| Rate for Payer: Kentucky WC Medicaid |
$576.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,360.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,224.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$497.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$581.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,459.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,244.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.19
|
| Rate for Payer: PHCS Commercial |
$1,592.32
|
| Rate for Payer: United Healthcare All Payer |
$1,459.63
|
|
|
POTASSIUM ALUM 10gm SDV
|
Facility
|
IP
|
$1,658.67
|
|
|
Service Code
|
NDC 24357030030
|
| Hospital Charge Code |
25004417
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$215.63 |
| Max. Negotiated Rate |
$1,592.32 |
| Rate for Payer: Aetna Commercial |
$1,277.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,293.76
|
| Rate for Payer: Cash Price |
$829.34
|
| Rate for Payer: Cigna Commercial |
$1,376.70
|
| Rate for Payer: First Health Commercial |
$1,575.74
|
| Rate for Payer: Humana Commercial |
$1,409.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,360.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,224.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$497.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,459.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,244.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$514.19
|
| Rate for Payer: PHCS Commercial |
$1,592.32
|
| Rate for Payer: United Healthcare All Payer |
$1,459.63
|
|
|
POTASSIUM CHLOR 20MEQ/15ML LIQ
|
Facility
|
IP
|
$11.50
|
|
|
Service Code
|
NDC 81033022051
|
| Hospital Charge Code |
25003366
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$8.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.97
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cigna Commercial |
$9.54
|
| Rate for Payer: First Health Commercial |
$10.92
|
| Rate for Payer: Humana Commercial |
$9.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.12
|
| Rate for Payer: Ohio Health Group HMO |
$8.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.56
|
| Rate for Payer: PHCS Commercial |
$11.04
|
| Rate for Payer: United Healthcare All Payer |
$10.12
|
|
|
POTASSIUM CHLOR 20MEQ/15ML LIQ
|
Facility
|
OP
|
$11.50
|
|
|
Service Code
|
NDC 81033022051
|
| Hospital Charge Code |
25003366
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$8.86
|
| Rate for Payer: Anthem Medicaid |
$3.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.97
|
| Rate for Payer: Cash Price |
$5.75
|
| Rate for Payer: Cigna Commercial |
$9.54
|
| Rate for Payer: First Health Commercial |
$10.92
|
| Rate for Payer: Humana Commercial |
$9.78
|
| Rate for Payer: Humana KY Medicaid |
$3.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.12
|
| Rate for Payer: Ohio Health Group HMO |
$8.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.56
|
| Rate for Payer: PHCS Commercial |
$11.04
|
| Rate for Payer: United Healthcare All Payer |
$10.12
|
|
|
POTASSIUM PHOSPH 32MMOL RDR
|
Facility
|
IP
|
$118.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$113.29 |
| Rate for Payer: Humana Commercial |
$100.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.85
|
| Rate for Payer: Ohio Health Group HMO |
$88.51
|
| 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 |
$113.29
|
| Rate for Payer: United Healthcare All Payer |
$103.85
|
| Rate for Payer: Aetna Commercial |
$90.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.05
|
| Rate for Payer: Cash Price |
$59.01
|
| Rate for Payer: Cigna Commercial |
$97.95
|
| Rate for Payer: First Health Commercial |
$112.11
|
|
|
POTASSIUM PHOSPH 32MMOL RDR
|
Facility
|
OP
|
$118.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003367
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$113.29 |
| Rate for Payer: Aetna Commercial |
$90.87
|
| Rate for Payer: Anthem Medicaid |
$40.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.05
|
| Rate for Payer: Cash Price |
$59.01
|
| Rate for Payer: Cigna Commercial |
$97.95
|
| Rate for Payer: First Health Commercial |
$112.11
|
| Rate for Payer: Humana Commercial |
$100.31
|
| Rate for Payer: Humana KY Medicaid |
$40.58
|
| Rate for Payer: Kentucky WC Medicaid |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.85
|
| Rate for Payer: Ohio Health Group HMO |
$88.51
|
| 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 |
$113.29
|
| Rate for Payer: United Healthcare All Payer |
$103.85
|
|
|
POTASSIUM PHOSPHAT 45MMOL/15ML
|
Facility
|
OP
|
$121.79
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$116.92 |
| Rate for Payer: Aetna Commercial |
$93.78
|
| Rate for Payer: Anthem Medicaid |
$41.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.00
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cigna Commercial |
$101.09
|
| Rate for Payer: First Health Commercial |
$115.70
|
| Rate for Payer: Humana Commercial |
$103.52
|
| Rate for Payer: Humana KY Medicaid |
$41.88
|
| Rate for Payer: Kentucky WC Medicaid |
$42.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.18
|
| Rate for Payer: Ohio Health Group HMO |
$91.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.75
|
| Rate for Payer: PHCS Commercial |
$116.92
|
| Rate for Payer: United Healthcare All Payer |
$107.18
|
|
|
POTASSIUM PHOSPHAT 45MMOL/15ML
|
Facility
|
IP
|
$121.79
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$116.92 |
| Rate for Payer: Aetna Commercial |
$93.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.00
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cigna Commercial |
$101.09
|
| Rate for Payer: First Health Commercial |
$115.70
|
| Rate for Payer: Humana Commercial |
$103.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.18
|
| Rate for Payer: Ohio Health Group HMO |
$91.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.75
|
| Rate for Payer: PHCS Commercial |
$116.92
|
| Rate for Payer: United Healthcare All Payer |
$107.18
|
|
|
POTASSIUM WHOLE BLOOD
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
30000480
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$58.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$6.52
|
| Rate for Payer: Healthspan PPO |
$4.82
|
| Rate for Payer: Multiplan PHCS |
$34.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$40.60
|
| Rate for Payer: UHCCP Medicaid |
$20.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.86
|
|
|
POTASSIUM WHOLE BLOOD
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
30000480
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$4.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.76
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Humana KY Medicaid |
$4.76
|
| Rate for Payer: Humana Medicare Advantage |
$4.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
POTASSIUM WHOLE BLOOD
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
30000480
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.57
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
POT CHLO(EA2MEG)20MEQ/60ML
|
Facility
|
OP
|
$79.98
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$76.78 |
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Anthem Medicaid |
$27.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.38
|
| Rate for Payer: Cash Price |
$39.99
|
| Rate for Payer: Cigna Commercial |
$66.38
|
| Rate for Payer: First Health Commercial |
$75.98
|
| Rate for Payer: Humana Commercial |
$67.98
|
| Rate for Payer: Humana KY Medicaid |
$27.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.38
|
| Rate for Payer: Ohio Health Group HMO |
$59.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.79
|
| Rate for Payer: PHCS Commercial |
$76.78
|
| Rate for Payer: United Healthcare All Payer |
$70.38
|
|
|
POT CHLO(EA2MEG)20MEQ/60ML
|
Facility
|
IP
|
$79.98
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$76.78 |
| Rate for Payer: Aetna Commercial |
$61.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.38
|
| Rate for Payer: Cash Price |
$39.99
|
| Rate for Payer: Cigna Commercial |
$66.38
|
| Rate for Payer: First Health Commercial |
$75.98
|
| Rate for Payer: Humana Commercial |
$67.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.38
|
| Rate for Payer: Ohio Health Group HMO |
$59.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.79
|
| Rate for Payer: PHCS Commercial |
$76.78
|
| Rate for Payer: United Healthcare All Payer |
$70.38
|
|
|
POT CHLORID (40 MEQ/270ML)
|
Facility
|
OP
|
$117.31
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002447
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$112.62 |
| Rate for Payer: Aetna Commercial |
$90.33
|
| Rate for Payer: Anthem Medicaid |
$40.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.50
|
| Rate for Payer: Cash Price |
$58.66
|
| Rate for Payer: Cigna Commercial |
$97.37
|
| Rate for Payer: First Health Commercial |
$111.44
|
| Rate for Payer: Humana Commercial |
$99.71
|
| Rate for Payer: Humana KY Medicaid |
$40.34
|
| Rate for Payer: Kentucky WC Medicaid |
$40.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.23
|
| Rate for Payer: Ohio Health Group HMO |
$87.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.37
|
| Rate for Payer: PHCS Commercial |
$112.62
|
| Rate for Payer: United Healthcare All Payer |
$103.23
|
|
|
POT CHLORID (40 MEQ/270ML)
|
Facility
|
IP
|
$117.31
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002447
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$112.62 |
| Rate for Payer: Aetna Commercial |
$90.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.50
|
| Rate for Payer: Cash Price |
$58.66
|
| Rate for Payer: Cigna Commercial |
$97.37
|
| Rate for Payer: First Health Commercial |
$111.44
|
| Rate for Payer: Humana Commercial |
$99.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.23
|
| Rate for Payer: Ohio Health Group HMO |
$87.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.37
|
| Rate for Payer: PHCS Commercial |
$112.62
|
| Rate for Payer: United Healthcare All Payer |
$103.23
|
|
|
POT CHLORIDE/WATER PER 2 MEQ
|
Facility
|
OP
|
$112.11
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25003363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$107.63 |
| Rate for Payer: Aetna Commercial |
$86.32
|
| Rate for Payer: Anthem Medicaid |
$38.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.45
|
| Rate for Payer: Cash Price |
$56.06
|
| Rate for Payer: Cigna Commercial |
$93.05
|
| Rate for Payer: First Health Commercial |
$106.50
|
| Rate for Payer: Humana Commercial |
$95.29
|
| Rate for Payer: Humana KY Medicaid |
$38.55
|
| Rate for Payer: Kentucky WC Medicaid |
$38.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.66
|
| Rate for Payer: Ohio Health Group HMO |
$84.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.75
|
| Rate for Payer: PHCS Commercial |
$107.63
|
| Rate for Payer: United Healthcare All Payer |
$98.66
|
|
|
POT CHLORIDE/WATER PER 2 MEQ
|
Facility
|
IP
|
$112.11
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25003363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$107.63 |
| Rate for Payer: Aetna Commercial |
$86.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.45
|
| Rate for Payer: Cash Price |
$56.06
|
| Rate for Payer: Cigna Commercial |
$93.05
|
| Rate for Payer: First Health Commercial |
$106.50
|
| Rate for Payer: Humana Commercial |
$95.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.66
|
| Rate for Payer: Ohio Health Group HMO |
$84.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.75
|
| Rate for Payer: PHCS Commercial |
$107.63
|
| Rate for Payer: United Healthcare All Payer |
$98.66
|
|
