|
POT CHLORID (40 MEQ/270ML)
|
Facility
|
OP
|
$117.31
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25002447
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.19 |
| 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 |
$93.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.94
|
| 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 |
$35.19 |
| 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 |
$93.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.94
|
| Rate for Payer: PHCS Commercial |
$112.62
|
| Rate for Payer: United Healthcare All Payer |
$103.23
|
|
|
POT CHLORIDE/WATER PER 2 MEQ
|
Facility
|
IP
|
$112.74
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25003363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$108.23 |
| Rate for Payer: Aetna Commercial |
$86.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.94
|
| Rate for Payer: Cash Price |
$56.37
|
| Rate for Payer: Cigna Commercial |
$93.57
|
| Rate for Payer: First Health Commercial |
$107.10
|
| Rate for Payer: Humana Commercial |
$95.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.21
|
| Rate for Payer: Ohio Health Group HMO |
$84.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.79
|
| Rate for Payer: PHCS Commercial |
$108.23
|
| Rate for Payer: United Healthcare All Payer |
$99.21
|
|
|
POT CHLORIDE/WATER PER 2 MEQ
|
Facility
|
OP
|
$112.74
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
25003363
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$108.23 |
| Rate for Payer: Aetna Commercial |
$86.81
|
| Rate for Payer: Anthem Medicaid |
$38.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.94
|
| Rate for Payer: Cash Price |
$56.37
|
| Rate for Payer: Cigna Commercial |
$93.57
|
| Rate for Payer: First Health Commercial |
$107.10
|
| Rate for Payer: Humana Commercial |
$95.83
|
| Rate for Payer: Humana KY Medicaid |
$38.77
|
| Rate for Payer: Kentucky WC Medicaid |
$39.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.21
|
| Rate for Payer: Ohio Health Group HMO |
$84.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.79
|
| Rate for Payer: PHCS Commercial |
$108.23
|
| Rate for Payer: United Healthcare All Payer |
$99.21
|
|
|
POTELIGEO 1mg (20mg Vial)
|
Facility
|
OP
|
$25,552.98
|
|
|
Service Code
|
HCPCS J9204
|
| Hospital Charge Code |
25004051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$24,530.86 |
| Rate for Payer: Aetna Commercial |
$19,675.79
|
| Rate for Payer: Anthem Medicaid |
$8,787.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$248.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,931.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$347.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$335.48
|
| Rate for Payer: Cash Price |
$12,776.49
|
| Rate for Payer: Cash Price |
$12,776.49
|
| Rate for Payer: Cigna Commercial |
$21,208.97
|
| Rate for Payer: First Health Commercial |
$24,275.33
|
| Rate for Payer: Humana Commercial |
$21,720.03
|
| Rate for Payer: Humana KY Medicaid |
$8,787.67
|
| Rate for Payer: Humana Medicare Advantage |
$248.50
|
| Rate for Payer: Kentucky WC Medicaid |
$8,877.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,953.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,858.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,963.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,486.62
|
| Rate for Payer: Ohio Health Group HMO |
$19,164.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,442.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,231.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,631.56
|
| Rate for Payer: PHCS Commercial |
$24,530.86
|
| Rate for Payer: United Healthcare All Payer |
$22,486.62
|
|
|
POTELIGEO 1mg (20mg Vial)
|
Facility
|
IP
|
$25,552.98
|
|
|
Service Code
|
HCPCS J9204
|
| Hospital Charge Code |
25004051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,665.89 |
| Max. Negotiated Rate |
$24,530.86 |
| Rate for Payer: Aetna Commercial |
$19,675.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,931.32
|
| Rate for Payer: Cash Price |
$12,776.49
|
| Rate for Payer: Cigna Commercial |
$21,208.97
|
| Rate for Payer: First Health Commercial |
$24,275.33
|
| Rate for Payer: Humana Commercial |
$21,720.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,953.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,858.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,665.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,486.62
|
| Rate for Payer: Ohio Health Group HMO |
$19,164.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,442.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,231.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,631.56
|
| Rate for Payer: PHCS Commercial |
$24,530.86
|
| Rate for Payer: United Healthcare All Payer |
$22,486.62
|
|
|
POWERCROSS .018 PTA 5*150*150
|
Facility
|
IP
|
$2,098.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.40 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
POWERCROSS .018 PTA 5*150*150
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.40 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem Medicaid |
$721.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Humana KY Medicaid |
$721.50
|
| Rate for Payer: Kentucky WC Medicaid |
$728.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$735.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
POWERCROSS .018 PTA 5*200*150
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
POWERCROSS .018 PTA 5*200*150
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem Medicaid |
$682.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Humana KY Medicaid |
$682.30
|
| Rate for Payer: Kentucky WC Medicaid |
$689.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
POWERCROSS .018 PTA 5*80*150
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
POWERCROSS .018 PTA 5*80*150
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem Medicaid |
$682.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Humana KY Medicaid |
$682.30
|
| Rate for Payer: Kentucky WC Medicaid |
$689.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
POWERCROSS .018 PTA 6*150*150
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.40 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem Medicaid |
$721.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Humana KY Medicaid |
$721.50
|
| Rate for Payer: Kentucky WC Medicaid |
$728.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$735.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
POWERCROSS .018 PTA 6*150*150
|
Facility
|
IP
|
$2,098.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.40 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
POWERCROSS .018 PTA 6*200*150
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.40 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem Medicaid |
$721.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Humana KY Medicaid |
$721.50
|
| Rate for Payer: Kentucky WC Medicaid |
$728.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$735.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
POWERCROSS .018 PTA 6*200*150
|
Facility
|
IP
|
$2,098.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.40 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
POWERCROSS .018 PTA 6*80*150
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
POWERCROSS .018 PTA 6*80*150
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem Medicaid |
$682.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Humana KY Medicaid |
$682.30
|
| Rate for Payer: Kentucky WC Medicaid |
$689.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
POWERFLOW APHERESIS PORT 9.6F
|
Facility
|
OP
|
$6,755.85
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,026.76 |
| Max. Negotiated Rate |
$6,485.62 |
| Rate for Payer: Aetna Commercial |
$5,202.00
|
| Rate for Payer: Anthem Medicaid |
$2,323.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,269.56
|
| Rate for Payer: Cash Price |
$3,377.93
|
| Rate for Payer: Cigna Commercial |
$5,607.36
|
| Rate for Payer: First Health Commercial |
$6,418.06
|
| Rate for Payer: Humana Commercial |
$5,742.47
|
| Rate for Payer: Humana KY Medicaid |
$2,323.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,346.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,539.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,985.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,026.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,369.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,945.15
|
| Rate for Payer: Ohio Health Group HMO |
$5,066.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,404.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,877.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,661.54
|
| Rate for Payer: PHCS Commercial |
$6,485.62
|
| Rate for Payer: United Healthcare All Payer |
$5,945.15
|
|
|
POWERFLOW APHERESIS PORT 9.6F
|
Facility
|
IP
|
$6,755.85
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,026.76 |
| Max. Negotiated Rate |
$6,485.62 |
| Rate for Payer: Aetna Commercial |
$5,202.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,269.56
|
| Rate for Payer: Cash Price |
$3,377.93
|
| Rate for Payer: Cigna Commercial |
$5,607.36
|
| Rate for Payer: First Health Commercial |
$6,418.06
|
| Rate for Payer: Humana Commercial |
$5,742.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,539.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,985.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,026.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,945.15
|
| Rate for Payer: Ohio Health Group HMO |
$5,066.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,404.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,877.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,661.54
|
| Rate for Payer: PHCS Commercial |
$6,485.62
|
| Rate for Payer: United Healthcare All Payer |
$5,945.15
|
|
|
POWERPORT 6.6F
|
Facility
|
IP
|
$1,877.60
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.28 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna Commercial |
$1,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.53
|
| Rate for Payer: Cash Price |
$938.80
|
| Rate for Payer: Cigna Commercial |
$1,558.41
|
| Rate for Payer: First Health Commercial |
$1,783.72
|
| Rate for Payer: Humana Commercial |
$1,595.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,633.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.54
|
| Rate for Payer: PHCS Commercial |
$1,802.50
|
| Rate for Payer: United Healthcare All Payer |
$1,652.29
|
|
|
POWERPORT 6.6F
|
Facility
|
OP
|
$1,877.60
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.28 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna Commercial |
$1,445.75
|
| Rate for Payer: Anthem Medicaid |
$645.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.53
|
| Rate for Payer: Cash Price |
$938.80
|
| Rate for Payer: Cigna Commercial |
$1,558.41
|
| Rate for Payer: First Health Commercial |
$1,783.72
|
| Rate for Payer: Humana Commercial |
$1,595.96
|
| Rate for Payer: Humana KY Medicaid |
$645.71
|
| Rate for Payer: Kentucky WC Medicaid |
$652.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,633.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.54
|
| Rate for Payer: PHCS Commercial |
$1,802.50
|
| Rate for Payer: United Healthcare All Payer |
$1,652.29
|
|
|
POWERPORT 8F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
POWERPORT 8F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
PPIL VAG DEL
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 58605
|
| Hospital Charge Code |
76102245
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
