|
SODIUM BICARBONATE 50MEQ/50ML
|
Facility
|
OP
|
$124.92
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna Commercial |
$96.19
|
| Rate for Payer: Anthem Medicaid |
$42.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.44
|
| Rate for Payer: Cash Price |
$62.46
|
| Rate for Payer: Cigna Commercial |
$103.68
|
| Rate for Payer: First Health Commercial |
$118.67
|
| Rate for Payer: Humana Commercial |
$106.18
|
| Rate for Payer: Humana KY Medicaid |
$42.96
|
| Rate for Payer: Kentucky WC Medicaid |
$43.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$109.93
|
| Rate for Payer: Ohio Health Group HMO |
$93.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.73
|
| Rate for Payer: PHCS Commercial |
$119.92
|
| Rate for Payer: United Healthcare All Payer |
$109.93
|
|
|
SODIUM BICARBONATE 50MEQ/50ML
|
Facility
|
OP
|
$116.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Commercial |
$89.97
|
| Rate for Payer: Anthem Medicaid |
$40.15
|
| Rate for Payer: Anthem Medicaid |
$40.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.14
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cigna Commercial |
$96.98
|
| Rate for Payer: Cigna Commercial |
$96.89
|
| Rate for Payer: First Health Commercial |
$111.00
|
| Rate for Payer: First Health Commercial |
$110.90
|
| Rate for Payer: Humana Commercial |
$99.23
|
| Rate for Payer: Humana Commercial |
$99.31
|
| Rate for Payer: Humana KY Medicaid |
$40.15
|
| Rate for Payer: Humana KY Medicaid |
$40.18
|
| Rate for Payer: Kentucky WC Medicaid |
$40.59
|
| Rate for Payer: Kentucky WC Medicaid |
$40.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.82
|
| Rate for Payer: Ohio Health Group HMO |
$87.56
|
| Rate for Payer: Ohio Health Group HMO |
$87.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.22
|
| Rate for Payer: PHCS Commercial |
$112.17
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.82
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
|
SODIUM BICARBONATE 50MEQ/50ML
|
Facility
|
IP
|
$124.92
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna Commercial |
$96.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.44
|
| Rate for Payer: Cash Price |
$62.46
|
| Rate for Payer: Cigna Commercial |
$103.68
|
| Rate for Payer: First Health Commercial |
$118.67
|
| Rate for Payer: Humana Commercial |
$106.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$109.93
|
| Rate for Payer: Ohio Health Group HMO |
$93.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.73
|
| Rate for Payer: PHCS Commercial |
$119.92
|
| Rate for Payer: United Healthcare All Payer |
$109.93
|
|
|
SODIUM BICARBONATE 50MEQ/50ML
|
Facility
|
IP
|
$116.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Commercial |
$89.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.14
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Cigna Commercial |
$96.89
|
| Rate for Payer: Cigna Commercial |
$96.98
|
| Rate for Payer: First Health Commercial |
$111.00
|
| Rate for Payer: First Health Commercial |
$110.90
|
| Rate for Payer: Humana Commercial |
$99.31
|
| Rate for Payer: Humana Commercial |
$99.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.82
|
| Rate for Payer: Ohio Health Group HMO |
$87.56
|
| Rate for Payer: Ohio Health Group HMO |
$87.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.19
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: PHCS Commercial |
$112.17
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
| Rate for Payer: United Healthcare All Payer |
$102.82
|
|
|
SODIUM BICARBONATE 50MEQ/50ML
|
Facility
|
OP
|
$111.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$107.27 |
| Rate for Payer: Aetna Commercial |
$86.04
|
| Rate for Payer: Anthem Medicaid |
$38.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.16
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Cigna Commercial |
$92.74
|
| Rate for Payer: First Health Commercial |
$106.15
|
| Rate for Payer: Humana Commercial |
$94.98
|
| Rate for Payer: Humana KY Medicaid |
$38.43
|
| Rate for Payer: Kentucky WC Medicaid |
$38.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.33
|
| Rate for Payer: Ohio Health Group HMO |
$83.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.64
|
| Rate for Payer: PHCS Commercial |
$107.27
|
| Rate for Payer: United Healthcare All Payer |
$98.33
|
|
|
SODIUM BICARBONATE 50MEQ/50ML
|
Facility
|
OP
|
$111.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$107.27 |
| Rate for Payer: Aetna Commercial |
$86.04
|
| Rate for Payer: Anthem Medicaid |
$38.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.16
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Cigna Commercial |
$92.74
|
| Rate for Payer: First Health Commercial |
$106.15
|
| Rate for Payer: Humana Commercial |
$94.98
|
| Rate for Payer: Humana KY Medicaid |
$38.43
|
| Rate for Payer: Kentucky WC Medicaid |
$38.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.33
|
| Rate for Payer: Ohio Health Group HMO |
$83.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.64
|
| Rate for Payer: PHCS Commercial |
$107.27
|
| Rate for Payer: United Healthcare All Payer |
$98.33
|
|
|
SODIUM BICARBONATE 50MEQ/50ML
|
Facility
|
IP
|
$111.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$107.27 |
| Rate for Payer: Aetna Commercial |
$86.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.16
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Cigna Commercial |
$92.74
|
| Rate for Payer: First Health Commercial |
$106.15
|
| Rate for Payer: Humana Commercial |
$94.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.33
|
| Rate for Payer: Ohio Health Group HMO |
$83.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.64
|
| Rate for Payer: PHCS Commercial |
$107.27
|
| Rate for Payer: United Healthcare All Payer |
$98.33
|
|
|
SODIUM BICARBONATE 50MEQ/50ML
|
Professional
|
Both
|
$111.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$111.74 |
| Rate for Payer: Buckeye Medicare Advantage |
$111.74
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$67.04
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.22
|
| Rate for Payer: UHCCP Medicaid |
$39.11
|
|
|
SODIUM BICARBONATE 50MEQ/50ML
|
Facility
|
IP
|
$111.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
636T0095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$107.27 |
| Rate for Payer: Aetna Commercial |
$86.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.16
|
| Rate for Payer: Cash Price |
$55.87
|
| Rate for Payer: Cigna Commercial |
$92.74
|
| Rate for Payer: First Health Commercial |
$106.15
|
| Rate for Payer: Humana Commercial |
$94.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.33
|
| Rate for Payer: Ohio Health Group HMO |
$83.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.64
|
| Rate for Payer: PHCS Commercial |
$107.27
|
| Rate for Payer: United Healthcare All Payer |
$98.33
|
|
|
SODIUM BICARBONATE 650MG/1TAB
|
Facility
|
OP
|
$4.22
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25001412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
SODIUM BICARBONATE 650MG/1TAB
|
Facility
|
IP
|
$4.22
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25001412
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
SODIUM BLOOD
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 84295
|
| Hospital Charge Code |
30000511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.16
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
SODIUM BLOOD
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 84295
|
| Hospital Charge Code |
30000511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$18.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.81
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Humana KY Medicaid |
$18.91
|
| Rate for Payer: Humana Medicare Advantage |
$4.81
|
| Rate for Payer: Kentucky WC Medicaid |
$19.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
SODIUM CHLOR 7% NEBULIZ V NEB
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
NDC 83490030760
|
| Hospital Charge Code |
25003453
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
SODIUM CHLOR 7% NEBULIZ V NEB
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 83490030760
|
| Hospital Charge Code |
25003453
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
SODIUM CHLOR/ALOE VERA 0.5OZ
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 225052547
|
| Hospital Charge Code |
25001415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna Commercial |
$0.15
|
| Rate for Payer: Anthem Medicaid |
$0.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna Commercial |
$0.17
|
| Rate for Payer: First Health Commercial |
$0.19
|
| Rate for Payer: Humana Commercial |
$0.17
|
| Rate for Payer: Humana KY Medicaid |
$0.07
|
| Rate for Payer: Kentucky WC Medicaid |
$0.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.18
|
| Rate for Payer: Ohio Health Group HMO |
$0.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.06
|
| Rate for Payer: PHCS Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Payer |
$0.18
|
|
|
SODIUM CHLOR/ALOE VERA 0.5OZ
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 225052547
|
| Hospital Charge Code |
25001415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: Aetna Commercial |
$0.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.16
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna Commercial |
$0.17
|
| Rate for Payer: First Health Commercial |
$0.19
|
| Rate for Payer: Humana Commercial |
$0.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.18
|
| Rate for Payer: Ohio Health Group HMO |
$0.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.06
|
| Rate for Payer: PHCS Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Payer |
$0.18
|
|
|
SODIUM CHLORIDE 0.9% 10mL SDV
|
Facility
|
IP
|
$60.89
|
|
| Hospital Charge Code |
636T0110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$58.45 |
| Rate for Payer: Aetna Commercial |
$46.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.49
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cigna Commercial |
$50.54
|
| Rate for Payer: First Health Commercial |
$57.85
|
| Rate for Payer: Humana Commercial |
$51.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.58
|
| Rate for Payer: Ohio Health Group HMO |
$45.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.88
|
| Rate for Payer: PHCS Commercial |
$58.45
|
| Rate for Payer: United Healthcare All Payer |
$53.58
|
|
|
SODIUM CHLORIDE 0.9% 10mL SDV
|
Facility
|
OP
|
$77.02
|
|
|
Service Code
|
NDC 63323018601
|
| Hospital Charge Code |
25003704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.94 |
| Rate for Payer: Aetna Commercial |
$59.31
|
| Rate for Payer: Anthem Medicaid |
$26.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.08
|
| Rate for Payer: Cash Price |
$38.51
|
| Rate for Payer: Cigna Commercial |
$63.93
|
| Rate for Payer: First Health Commercial |
$73.17
|
| Rate for Payer: Humana Commercial |
$65.47
|
| Rate for Payer: Humana KY Medicaid |
$26.49
|
| Rate for Payer: Kentucky WC Medicaid |
$26.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.78
|
| Rate for Payer: Ohio Health Group HMO |
$57.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.88
|
| Rate for Payer: PHCS Commercial |
$73.94
|
| Rate for Payer: United Healthcare All Payer |
$67.78
|
|
|
SODIUM CHLORIDE 0.9% 10mL SDV
|
Professional
|
Both
|
$60.89
|
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$60.89 |
| Rate for Payer: Buckeye Medicare Advantage |
$60.89
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Multiplan PHCS |
$36.53
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.62
|
| Rate for Payer: UHCCP Medicaid |
$21.31
|
|
|
SODIUM CHLORIDE 0.9% 10mL SDV
|
Facility
|
IP
|
$60.89
|
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$58.45 |
| Rate for Payer: Aetna Commercial |
$46.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.49
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cigna Commercial |
$50.54
|
| Rate for Payer: First Health Commercial |
$57.85
|
| Rate for Payer: Humana Commercial |
$51.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.58
|
| Rate for Payer: Ohio Health Group HMO |
$45.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.88
|
| Rate for Payer: PHCS Commercial |
$58.45
|
| Rate for Payer: United Healthcare All Payer |
$53.58
|
|
|
SODIUM CHLORIDE 0.9% 10mL SDV
|
Facility
|
IP
|
$77.02
|
|
|
Service Code
|
NDC 63323018601
|
| Hospital Charge Code |
25003704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.94 |
| Rate for Payer: Aetna Commercial |
$59.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.08
|
| Rate for Payer: Cash Price |
$38.51
|
| Rate for Payer: Cigna Commercial |
$63.93
|
| Rate for Payer: First Health Commercial |
$73.17
|
| Rate for Payer: Humana Commercial |
$65.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.78
|
| Rate for Payer: Ohio Health Group HMO |
$57.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.88
|
| Rate for Payer: PHCS Commercial |
$73.94
|
| Rate for Payer: United Healthcare All Payer |
$67.78
|
|
|
SODIUM CHLORIDE 0.9% 10mL SDV
|
Facility
|
OP
|
$60.89
|
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$58.45 |
| Rate for Payer: Aetna Commercial |
$46.89
|
| Rate for Payer: Anthem Medicaid |
$20.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.49
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cigna Commercial |
$50.54
|
| Rate for Payer: First Health Commercial |
$57.85
|
| Rate for Payer: Humana Commercial |
$51.76
|
| Rate for Payer: Humana KY Medicaid |
$20.94
|
| Rate for Payer: Kentucky WC Medicaid |
$21.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.58
|
| Rate for Payer: Ohio Health Group HMO |
$45.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.88
|
| Rate for Payer: PHCS Commercial |
$58.45
|
| Rate for Payer: United Healthcare All Payer |
$53.58
|
|
|
SODIUM CHLORIDE 0.9% 10mL SDV
|
Facility
|
OP
|
$60.89
|
|
| Hospital Charge Code |
636T0110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$58.45 |
| Rate for Payer: Aetna Commercial |
$46.89
|
| Rate for Payer: Anthem Medicaid |
$20.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.49
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cigna Commercial |
$50.54
|
| Rate for Payer: First Health Commercial |
$57.85
|
| Rate for Payer: Humana Commercial |
$51.76
|
| Rate for Payer: Humana KY Medicaid |
$20.94
|
| Rate for Payer: Kentucky WC Medicaid |
$21.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.58
|
| Rate for Payer: Ohio Health Group HMO |
$45.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.88
|
| Rate for Payer: PHCS Commercial |
$58.45
|
| Rate for Payer: United Healthcare All Payer |
$53.58
|
|
|
SODIUM CHLORIDE 0.9% 150ML BAG
|
Facility
|
OP
|
$112.25
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$107.76 |
| Rate for Payer: Aetna Commercial |
$86.43
|
| Rate for Payer: Anthem Medicaid |
$38.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.56
|
| Rate for Payer: Cash Price |
$56.12
|
| Rate for Payer: Cigna Commercial |
$93.17
|
| Rate for Payer: First Health Commercial |
$106.64
|
| Rate for Payer: Humana Commercial |
$95.41
|
| Rate for Payer: Humana KY Medicaid |
$38.60
|
| Rate for Payer: Kentucky WC Medicaid |
$39.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.78
|
| Rate for Payer: Ohio Health Group HMO |
$84.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.80
|
| Rate for Payer: PHCS Commercial |
$107.76
|
| Rate for Payer: United Healthcare All Payer |
$98.78
|
|
