|
POST TAPER 8.5MM*25MM LG CE
|
Facility
|
OP
|
$4,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.75 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: Aetna Commercial |
$3,682.53
|
| Rate for Payer: Anthem Medicaid |
$1,644.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,730.35
|
| Rate for Payer: Cash Price |
$2,391.25
|
| Rate for Payer: Cigna Commercial |
$3,969.47
|
| Rate for Payer: First Health Commercial |
$4,543.38
|
| Rate for Payer: Humana Commercial |
$4,065.12
|
| Rate for Payer: Humana KY Medicaid |
$1,644.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,661.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,677.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,826.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.93
|
| Rate for Payer: PHCS Commercial |
$4,591.20
|
| Rate for Payer: United Healthcare All Payer |
$4,208.60
|
|
|
POST TAPER 8.5MM*25MM LG CE
|
Facility
|
IP
|
$4,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.75 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: Aetna Commercial |
$3,682.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,730.35
|
| Rate for Payer: Cash Price |
$2,391.25
|
| Rate for Payer: Cigna Commercial |
$3,969.47
|
| Rate for Payer: First Health Commercial |
$4,543.38
|
| Rate for Payer: Humana Commercial |
$4,065.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,826.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.93
|
| Rate for Payer: PHCS Commercial |
$4,591.20
|
| Rate for Payer: United Healthcare All Payer |
$4,208.60
|
|
|
POST TAPER HUM HEAD 13.5*31 CE
|
Facility
|
IP
|
$4,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.75 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: Aetna Commercial |
$3,682.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,730.35
|
| Rate for Payer: Cash Price |
$2,391.25
|
| Rate for Payer: Cigna Commercial |
$3,969.47
|
| Rate for Payer: First Health Commercial |
$4,543.38
|
| Rate for Payer: Humana Commercial |
$4,065.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,826.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.93
|
| Rate for Payer: PHCS Commercial |
$4,591.20
|
| Rate for Payer: United Healthcare All Payer |
$4,208.60
|
|
|
POST TAPER HUM HEAD 13.5*31 CE
|
Facility
|
OP
|
$4,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.75 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: Aetna Commercial |
$3,682.53
|
| Rate for Payer: Anthem Medicaid |
$1,644.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,730.35
|
| Rate for Payer: Cash Price |
$2,391.25
|
| Rate for Payer: Cigna Commercial |
$3,969.47
|
| Rate for Payer: First Health Commercial |
$4,543.38
|
| Rate for Payer: Humana Commercial |
$4,065.12
|
| Rate for Payer: Humana KY Medicaid |
$1,644.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,661.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,677.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,826.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.93
|
| Rate for Payer: PHCS Commercial |
$4,591.20
|
| Rate for Payer: United Healthcare All Payer |
$4,208.60
|
|
|
POST TAPER HUM HEAD 13.7*31 CE
|
Facility
|
IP
|
$4,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.75 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: Aetna Commercial |
$3,682.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,730.35
|
| Rate for Payer: Cash Price |
$2,391.25
|
| Rate for Payer: Cigna Commercial |
$3,969.47
|
| Rate for Payer: First Health Commercial |
$4,543.38
|
| Rate for Payer: Humana Commercial |
$4,065.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,826.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.93
|
| Rate for Payer: PHCS Commercial |
$4,591.20
|
| Rate for Payer: United Healthcare All Payer |
$4,208.60
|
|
|
POST TAPER HUM HEAD 13.7*31 CE
|
Facility
|
OP
|
$4,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.75 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: Aetna Commercial |
$3,682.53
|
| Rate for Payer: Anthem Medicaid |
$1,644.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,730.35
|
| Rate for Payer: Cash Price |
$2,391.25
|
| Rate for Payer: Cigna Commercial |
$3,969.47
|
| Rate for Payer: First Health Commercial |
$4,543.38
|
| Rate for Payer: Humana Commercial |
$4,065.12
|
| Rate for Payer: Humana KY Medicaid |
$1,644.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,661.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,677.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,826.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.93
|
| Rate for Payer: PHCS Commercial |
$4,591.20
|
| Rate for Payer: United Healthcare All Payer |
$4,208.60
|
|
|
POST VASECTOMY SEMEN ANALYSIS
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 89321
|
| Hospital Charge Code |
30001550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| 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 |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.76
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
POST VASECTOMY SEMEN ANALYSIS
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 89321
|
| Hospital Charge Code |
30001550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.51
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.76
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
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 |
$23.94 |
| 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 |
$63.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.06
|
| Rate for Payer: PHCS Commercial |
$76.61
|
| Rate for Payer: United Healthcare All Payer |
$70.22
|
|
|
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 |
$23.94 |
| 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 |
$63.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.06
|
| Rate for Payer: PHCS Commercial |
$76.61
|
| Rate for Payer: United Healthcare All Payer |
$70.22
|
|
|
POTASSIUM ACETATE 40MEQ/20ML
|
Facility
|
IP
|
$112.39
|
|
|
Service Code
|
NDC 409818301
|
| Hospital Charge Code |
25003365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.72 |
| Max. Negotiated Rate |
$107.89 |
| Rate for Payer: Aetna Commercial |
$86.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.66
|
| Rate for Payer: Cash Price |
$56.20
|
| Rate for Payer: Cigna Commercial |
$93.28
|
| Rate for Payer: First Health Commercial |
$106.77
|
| Rate for Payer: Humana Commercial |
$95.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.90
|
| Rate for Payer: Ohio Health Group HMO |
$84.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.55
|
| Rate for Payer: PHCS Commercial |
$107.89
|
| Rate for Payer: United Healthcare All Payer |
$98.90
|
|
|
POTASSIUM ACETATE 40MEQ/20ML
|
Facility
|
OP
|
$112.39
|
|
|
Service Code
|
NDC 409818301
|
| Hospital Charge Code |
25003365
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.72 |
| Max. Negotiated Rate |
$107.89 |
| Rate for Payer: Aetna Commercial |
$86.54
|
| Rate for Payer: Anthem Medicaid |
$38.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.66
|
| Rate for Payer: Cash Price |
$56.20
|
| Rate for Payer: Cigna Commercial |
$93.28
|
| Rate for Payer: First Health Commercial |
$106.77
|
| Rate for Payer: Humana Commercial |
$95.53
|
| Rate for Payer: Humana KY Medicaid |
$38.65
|
| Rate for Payer: Kentucky WC Medicaid |
$39.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.90
|
| Rate for Payer: Ohio Health Group HMO |
$84.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.55
|
| Rate for Payer: PHCS Commercial |
$107.89
|
| Rate for Payer: United Healthcare All Payer |
$98.90
|
|
|
POTASSIUM ALUM 10gm SDV
|
Facility
|
OP
|
$1,658.67
|
|
|
Service Code
|
NDC 24357030030
|
| Hospital Charge Code |
25004417
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$497.60 |
| 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 |
$1,326.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,443.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,144.48
|
| 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 |
$497.60 |
| 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 |
$1,326.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,443.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,144.48
|
| 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 |
$3.45 |
| 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 |
$10.93
|
| 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 |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.93
|
| 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 |
$3.45 |
| 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 |
$10.93
|
| 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 |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.93
|
| Rate for Payer: PHCS Commercial |
$11.04
|
| Rate for Payer: United Healthcare All Payer |
$10.12
|
|
|
POTASSIUM PHOSPH 32MMOL RDR
|
Facility
|
IP
|
$121.34
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003367
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Aetna Commercial |
$93.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.65
|
| Rate for Payer: Cash Price |
$60.67
|
| Rate for Payer: Cigna Commercial |
$100.71
|
| Rate for Payer: First Health Commercial |
$115.27
|
| Rate for Payer: Humana Commercial |
$103.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.78
|
| Rate for Payer: Ohio Health Group HMO |
$91.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.72
|
| Rate for Payer: PHCS Commercial |
$116.49
|
| Rate for Payer: United Healthcare All Payer |
$106.78
|
|
|
POTASSIUM PHOSPH 32MMOL RDR
|
Facility
|
OP
|
$121.34
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003367
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Aetna Commercial |
$93.43
|
| Rate for Payer: Anthem Medicaid |
$41.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.65
|
| Rate for Payer: Cash Price |
$60.67
|
| Rate for Payer: Cigna Commercial |
$100.71
|
| Rate for Payer: First Health Commercial |
$115.27
|
| Rate for Payer: Humana Commercial |
$103.14
|
| Rate for Payer: Humana KY Medicaid |
$41.73
|
| Rate for Payer: Kentucky WC Medicaid |
$42.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.78
|
| Rate for Payer: Ohio Health Group HMO |
$91.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.72
|
| Rate for Payer: PHCS Commercial |
$116.49
|
| Rate for Payer: United Healthcare All Payer |
$106.78
|
|
|
POTASSIUM PHOSPHAT 45MMOL/15ML
|
Facility
|
IP
|
$121.79
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.54 |
| 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 |
$97.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.04
|
| Rate for Payer: PHCS Commercial |
$116.92
|
| Rate for Payer: United Healthcare All Payer |
$107.18
|
|
|
POTASSIUM PHOSPHAT 45MMOL/15ML
|
Facility
|
OP
|
$121.79
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002444
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.54 |
| 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 |
$97.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.04
|
| Rate for Payer: PHCS Commercial |
$116.92
|
| Rate for Payer: United Healthcare All Payer |
$107.18
|
|
|
POTASSIUM WHOLE BLOOD
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
30000480
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$36.60 |
| Rate for Payer: Aetna Commercial |
$10.73
|
| Rate for Payer: Ambetter Exchange |
$4.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.71
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$6.52
|
| Rate for Payer: Healthspan PPO |
$4.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.76
|
| Rate for Payer: Multiplan PHCS |
$36.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6.19
|
| Rate for Payer: UHCCP Medicaid |
$21.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.76
|
|
|
POTASSIUM WHOLE BLOOD
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
30000480
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.09
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
POTASSIUM WHOLE BLOOD
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
30000480
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem Medicaid |
$4.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.76
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| 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 |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.09
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
POT CHLO(EA2MEG)20MEQ/60ML
|
Facility
|
IP
|
$112.50
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$86.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.75
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna Commercial |
$93.38
|
| Rate for Payer: First Health Commercial |
$106.88
|
| Rate for Payer: Humana Commercial |
$95.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.00
|
| Rate for Payer: Ohio Health Group HMO |
$84.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.62
|
| Rate for Payer: PHCS Commercial |
$108.00
|
| Rate for Payer: United Healthcare All Payer |
$99.00
|
|
|
POT CHLO(EA2MEG)20MEQ/60ML
|
Facility
|
OP
|
$112.50
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$86.62
|
| Rate for Payer: Anthem Medicaid |
$38.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.75
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna Commercial |
$93.38
|
| Rate for Payer: First Health Commercial |
$106.88
|
| Rate for Payer: Humana Commercial |
$95.62
|
| Rate for Payer: Humana KY Medicaid |
$38.69
|
| Rate for Payer: Kentucky WC Medicaid |
$39.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.00
|
| Rate for Payer: Ohio Health Group HMO |
$84.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.62
|
| Rate for Payer: PHCS Commercial |
$108.00
|
| Rate for Payer: United Healthcare All Payer |
$99.00
|
|
