|
SMOKE TOBAC CESSATION > 10 MIN
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
94200010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna Commercial |
$37.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.48
|
| Rate for Payer: Anthem Medicaid |
$20.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.00
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$36.48
|
| Rate for Payer: Healthspan PPO |
$30.62
|
| Rate for Payer: Humana Medicaid |
$20.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.79
|
| Rate for Payer: Molina Healthcare Passport |
$20.38
|
| Rate for Payer: Multiplan PHCS |
$53.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$62.30
|
| Rate for Payer: UHCCP Medicaid |
$30.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.58
|
|
|
SMOKE TOBAC CESSATION > 10 MIN
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
94200010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$85.44 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.42
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$73.87
|
| Rate for Payer: First Health Commercial |
$84.55
|
| Rate for Payer: Humana Commercial |
$75.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$78.32
|
| Rate for Payer: Ohio Health Group HMO |
$66.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.59
|
| Rate for Payer: PHCS Commercial |
$85.44
|
| Rate for Payer: United Healthcare All Payer |
$78.32
|
|
|
SMOKE TOBAC CESSATION 3-10 MIN
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
SMOKE TOBAC CESSATION 3-10 MIN
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$24.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.49
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$24.76
|
| Rate for Payer: Humana Medicare Advantage |
$24.81
|
| Rate for Payer: Kentucky WC Medicaid |
$25.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.32
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
SMOKE TOBAC CESSATION 3-10 MIN
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.72
|
| Rate for Payer: Anthem Medicaid |
$9.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$18.48
|
| Rate for Payer: Healthspan PPO |
$15.98
|
| Rate for Payer: Humana Medicaid |
$9.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.97
|
| Rate for Payer: Molina Healthcare Passport |
$9.77
|
| Rate for Payer: Multiplan PHCS |
$43.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.40
|
| Rate for Payer: UHCCP Medicaid |
$8.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.87
|
|
|
SMOKING CESS >3-10 MIN
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200018
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$22.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.49
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Humana KY Medicaid |
$22.70
|
| Rate for Payer: Humana Medicare Advantage |
$24.81
|
| Rate for Payer: Kentucky WC Medicaid |
$22.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.46
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
SMOKING CESS >3-10 MIN
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200018
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.48
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.46
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
SMOKING CESS >3-10 MIN
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200018
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.72
|
| Rate for Payer: Anthem Medicaid |
$9.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$18.48
|
| Rate for Payer: Healthspan PPO |
$15.98
|
| Rate for Payer: Humana Medicaid |
$9.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.97
|
| Rate for Payer: Molina Healthcare Passport |
$9.77
|
| Rate for Payer: Multiplan PHCS |
$39.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.20
|
| Rate for Payer: UHCCP Medicaid |
$8.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.87
|
|
|
SOALR OFFSET HUM HEAD 50*15
|
Facility
|
OP
|
$7,874.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.74 |
| Max. Negotiated Rate |
$7,559.96 |
| Rate for Payer: Aetna Commercial |
$6,063.72
|
| Rate for Payer: Anthem Medicaid |
$2,708.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.47
|
| Rate for Payer: Cash Price |
$3,937.48
|
| Rate for Payer: Cigna Commercial |
$6,536.22
|
| Rate for Payer: First Health Commercial |
$7,481.21
|
| Rate for Payer: Humana Commercial |
$6,693.72
|
| Rate for Payer: Humana KY Medicaid |
$2,708.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,735.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,811.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,762.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,929.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,441.24
|
| Rate for Payer: PHCS Commercial |
$7,559.96
|
| Rate for Payer: United Healthcare All Payer |
$6,929.96
|
|
|
SOALR OFFSET HUM HEAD 50*15
|
Facility
|
IP
|
$7,874.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.74 |
| Max. Negotiated Rate |
$7,559.96 |
| Rate for Payer: Aetna Commercial |
$6,063.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.47
|
| Rate for Payer: Cash Price |
$3,937.48
|
| Rate for Payer: Cigna Commercial |
$6,536.22
|
| Rate for Payer: First Health Commercial |
$7,481.21
|
| Rate for Payer: Humana Commercial |
$6,693.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,811.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,929.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,441.24
|
| Rate for Payer: PHCS Commercial |
$7,559.96
|
| Rate for Payer: United Healthcare All Payer |
$6,929.96
|
|
|
SOD BICARB4.2%0.5MEQMLSYR10ML
|
Facility
|
OP
|
$122.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003448
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$117.23 |
| Rate for Payer: Aetna Commercial |
$94.02
|
| Rate for Payer: Anthem Medicaid |
$41.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.25
|
| Rate for Payer: Cash Price |
$61.06
|
| Rate for Payer: Cigna Commercial |
$101.35
|
| Rate for Payer: First Health Commercial |
$116.00
|
| Rate for Payer: Humana Commercial |
$103.79
|
| Rate for Payer: Humana KY Medicaid |
$41.99
|
| Rate for Payer: Kentucky WC Medicaid |
$42.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.46
|
| Rate for Payer: Ohio Health Group HMO |
$91.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.85
|
| Rate for Payer: PHCS Commercial |
$117.23
|
| Rate for Payer: United Healthcare All Payer |
$107.46
|
|
|
SOD BICARB4.2%0.5MEQMLSYR10ML
|
Facility
|
IP
|
$122.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003448
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$117.23 |
| Rate for Payer: Aetna Commercial |
$94.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.25
|
| Rate for Payer: Cash Price |
$61.06
|
| Rate for Payer: Cigna Commercial |
$101.35
|
| Rate for Payer: First Health Commercial |
$116.00
|
| Rate for Payer: Humana Commercial |
$103.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.46
|
| Rate for Payer: Ohio Health Group HMO |
$91.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.85
|
| Rate for Payer: PHCS Commercial |
$117.23
|
| Rate for Payer: United Healthcare All Payer |
$107.46
|
|
|
SOD CHLORIDE 0.9%IRRIG 1000ML
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
25003463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Anthem Medicaid |
$7.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.36
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: First Health Commercial |
$21.14
|
| Rate for Payer: Humana Commercial |
$18.91
|
| Rate for Payer: Humana KY Medicaid |
$7.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.58
|
| Rate for Payer: Ohio Health Group HMO |
$16.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
SOD CHLORIDE 0.9%IRRIG 1000ML
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
25003463
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.36
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: First Health Commercial |
$21.14
|
| Rate for Payer: Humana Commercial |
$18.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.58
|
| Rate for Payer: Ohio Health Group HMO |
$16.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
SOD CHLORIDE 23.4% SOLU 250ML
|
Facility
|
IP
|
$113.71
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25003464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$109.16 |
| Rate for Payer: Aetna Commercial |
$87.56
|
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.36
|
| Rate for Payer: Cash Price |
$56.85
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cigna Commercial |
$94.38
|
| Rate for Payer: Cigna Commercial |
$66.36
|
| Rate for Payer: First Health Commercial |
$75.95
|
| Rate for Payer: First Health Commercial |
$108.02
|
| Rate for Payer: Humana Commercial |
$67.96
|
| Rate for Payer: Humana Commercial |
$96.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.36
|
| Rate for Payer: Ohio Health Group HMO |
$85.28
|
| Rate for Payer: Ohio Health Group HMO |
$59.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.25
|
| Rate for Payer: PHCS Commercial |
$109.16
|
| Rate for Payer: PHCS Commercial |
$76.75
|
| Rate for Payer: United Healthcare All Payer |
$100.06
|
| Rate for Payer: United Healthcare All Payer |
$70.36
|
|
|
SOD CHLORIDE 23.4% SOLU 250ML
|
Facility
|
OP
|
$113.71
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25003464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$109.16 |
| Rate for Payer: Aetna Commercial |
$87.56
|
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Anthem Medicaid |
$39.10
|
| Rate for Payer: Anthem Medicaid |
$27.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.36
|
| Rate for Payer: Cash Price |
$56.85
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cigna Commercial |
$66.36
|
| Rate for Payer: Cigna Commercial |
$94.38
|
| Rate for Payer: First Health Commercial |
$75.95
|
| Rate for Payer: First Health Commercial |
$108.02
|
| Rate for Payer: Humana Commercial |
$96.65
|
| Rate for Payer: Humana Commercial |
$67.96
|
| Rate for Payer: Humana KY Medicaid |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$27.49
|
| Rate for Payer: Kentucky WC Medicaid |
$27.77
|
| Rate for Payer: Kentucky WC Medicaid |
$39.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.36
|
| Rate for Payer: Ohio Health Group HMO |
$85.28
|
| Rate for Payer: Ohio Health Group HMO |
$59.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.78
|
| Rate for Payer: PHCS Commercial |
$76.75
|
| Rate for Payer: PHCS Commercial |
$109.16
|
| Rate for Payer: United Healthcare All Payer |
$70.36
|
| Rate for Payer: United Healthcare All Payer |
$100.06
|
|
|
SODIUM ACETATE 40MEQ/20ML
|
Facility
|
OP
|
$79.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003447
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$76.03 |
| Rate for Payer: Aetna Commercial |
$60.98
|
| Rate for Payer: Anthem Medicaid |
$27.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.78
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$65.74
|
| Rate for Payer: First Health Commercial |
$75.24
|
| Rate for Payer: Humana Commercial |
$67.32
|
| Rate for Payer: Humana KY Medicaid |
$27.24
|
| Rate for Payer: Kentucky WC Medicaid |
$27.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.70
|
| Rate for Payer: Ohio Health Group HMO |
$59.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.55
|
| Rate for Payer: PHCS Commercial |
$76.03
|
| Rate for Payer: United Healthcare All Payer |
$69.70
|
|
|
SODIUM ACETATE 40MEQ/20ML
|
Facility
|
IP
|
$79.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003447
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$76.03 |
| Rate for Payer: Aetna Commercial |
$60.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.78
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$65.74
|
| Rate for Payer: First Health Commercial |
$75.24
|
| Rate for Payer: Humana Commercial |
$67.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.70
|
| Rate for Payer: Ohio Health Group HMO |
$59.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.55
|
| Rate for Payer: PHCS Commercial |
$76.03
|
| Rate for Payer: United Healthcare All Payer |
$69.70
|
|
|
SODIUM BICARBONATE 10MEQ/10ML
|
Facility
|
OP
|
$126.51
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$121.45 |
| Rate for Payer: Aetna Commercial |
$97.41
|
| Rate for Payer: Anthem Medicaid |
$43.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.68
|
| Rate for Payer: Cash Price |
$63.26
|
| Rate for Payer: Cigna Commercial |
$105.00
|
| Rate for Payer: First Health Commercial |
$120.18
|
| Rate for Payer: Humana Commercial |
$107.53
|
| Rate for Payer: Humana KY Medicaid |
$43.51
|
| Rate for Payer: Kentucky WC Medicaid |
$43.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.33
|
| Rate for Payer: Ohio Health Group HMO |
$94.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.22
|
| Rate for Payer: PHCS Commercial |
$121.45
|
| Rate for Payer: United Healthcare All Payer |
$111.33
|
|
|
SODIUM BICARBONATE 10MEQ/10ML
|
Facility
|
IP
|
$126.51
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$121.45 |
| Rate for Payer: Aetna Commercial |
$97.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.68
|
| Rate for Payer: Cash Price |
$63.26
|
| Rate for Payer: Cigna Commercial |
$105.00
|
| Rate for Payer: First Health Commercial |
$120.18
|
| Rate for Payer: Humana Commercial |
$107.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.33
|
| Rate for Payer: Ohio Health Group HMO |
$94.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.22
|
| Rate for Payer: PHCS Commercial |
$121.45
|
| Rate for Payer: United Healthcare All Payer |
$111.33
|
|
|
SODIUM BICARBONATE 10MEQ/10ML
|
Facility
|
IP
|
$121.51
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$116.65 |
| Rate for Payer: Aetna Commercial |
$93.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.78
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cigna Commercial |
$100.85
|
| Rate for Payer: First Health Commercial |
$115.43
|
| Rate for Payer: Humana Commercial |
$103.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.93
|
| Rate for Payer: Ohio Health Group HMO |
$91.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.67
|
| Rate for Payer: PHCS Commercial |
$116.65
|
| Rate for Payer: United Healthcare All Payer |
$106.93
|
|
|
SODIUM BICARBONATE 10MEQ/10ML
|
Facility
|
IP
|
$121.51
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$116.65 |
| Rate for Payer: Aetna Commercial |
$93.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.78
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cigna Commercial |
$100.85
|
| Rate for Payer: First Health Commercial |
$115.43
|
| Rate for Payer: Humana Commercial |
$103.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.93
|
| Rate for Payer: Ohio Health Group HMO |
$91.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.67
|
| Rate for Payer: PHCS Commercial |
$116.65
|
| Rate for Payer: United Healthcare All Payer |
$106.93
|
|
|
SODIUM BICARBONATE 10MEQ/10ML
|
Professional
|
Both
|
$121.51
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$121.51 |
| Rate for Payer: Buckeye Medicare Advantage |
$121.51
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$72.91
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.06
|
| Rate for Payer: UHCCP Medicaid |
$42.53
|
|
|
SODIUM BICARBONATE 10MEQ/10ML
|
Facility
|
OP
|
$121.51
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$116.65 |
| Rate for Payer: Aetna Commercial |
$93.56
|
| Rate for Payer: Anthem Medicaid |
$41.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.78
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cigna Commercial |
$100.85
|
| Rate for Payer: First Health Commercial |
$115.43
|
| Rate for Payer: Humana Commercial |
$103.28
|
| Rate for Payer: Humana KY Medicaid |
$41.79
|
| Rate for Payer: Kentucky WC Medicaid |
$42.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.93
|
| Rate for Payer: Ohio Health Group HMO |
$91.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.67
|
| Rate for Payer: PHCS Commercial |
$116.65
|
| Rate for Payer: United Healthcare All Payer |
$106.93
|
|
|
SODIUM BICARBONATE 10MEQ/10ML
|
Facility
|
OP
|
$121.51
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$116.65 |
| Rate for Payer: Aetna Commercial |
$93.56
|
| Rate for Payer: Anthem Medicaid |
$41.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.78
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cigna Commercial |
$100.85
|
| Rate for Payer: First Health Commercial |
$115.43
|
| Rate for Payer: Humana Commercial |
$103.28
|
| Rate for Payer: Humana KY Medicaid |
$41.79
|
| Rate for Payer: Kentucky WC Medicaid |
$42.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.93
|
| Rate for Payer: Ohio Health Group HMO |
$91.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.67
|
| Rate for Payer: PHCS Commercial |
$116.65
|
| Rate for Payer: United Healthcare All Payer |
$106.93
|
|
