|
SODIUM CHLORIDE 0.9% 150ML BAG
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
SODIUM CHLORIDE 0.9% 20mL SDV
|
Professional
|
Both
|
$74.30
|
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Buckeye Medicare Advantage |
$74.30
|
| Rate for Payer: Cash Price |
$37.15
|
| Rate for Payer: Multiplan PHCS |
$44.58
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.01
|
| Rate for Payer: UHCCP Medicaid |
$26.00
|
|
|
SODIUM CHLORIDE 0.9% 20mL SDV
|
Facility
|
IP
|
$74.30
|
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$71.33 |
| Rate for Payer: Aetna Commercial |
$57.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.95
|
| Rate for Payer: Cash Price |
$37.15
|
| Rate for Payer: Cigna Commercial |
$61.67
|
| Rate for Payer: First Health Commercial |
$70.58
|
| Rate for Payer: Humana Commercial |
$63.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.38
|
| Rate for Payer: Ohio Health Group HMO |
$55.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.03
|
| Rate for Payer: PHCS Commercial |
$71.33
|
| Rate for Payer: United Healthcare All Payer |
$65.38
|
|
|
SODIUM CHLORIDE 0.9% 20mL SDV
|
Facility
|
OP
|
$77.30
|
|
|
Service Code
|
NDC 409488803
|
| Hospital Charge Code |
25004361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$74.21 |
| Rate for Payer: Aetna Commercial |
$59.52
|
| Rate for Payer: Anthem Medicaid |
$26.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.29
|
| Rate for Payer: Cash Price |
$38.65
|
| Rate for Payer: Cigna Commercial |
$64.16
|
| Rate for Payer: First Health Commercial |
$73.44
|
| Rate for Payer: Humana Commercial |
$65.70
|
| Rate for Payer: Humana KY Medicaid |
$26.58
|
| Rate for Payer: Kentucky WC Medicaid |
$26.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.02
|
| Rate for Payer: Ohio Health Group HMO |
$57.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.96
|
| Rate for Payer: PHCS Commercial |
$74.21
|
| Rate for Payer: United Healthcare All Payer |
$68.02
|
|
|
SODIUM CHLORIDE 0.9% 20mL SDV
|
Facility
|
OP
|
$74.30
|
|
| Hospital Charge Code |
636T0187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$71.33 |
| Rate for Payer: Aetna Commercial |
$57.21
|
| Rate for Payer: Anthem Medicaid |
$25.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.95
|
| Rate for Payer: Cash Price |
$37.15
|
| Rate for Payer: Cigna Commercial |
$61.67
|
| Rate for Payer: First Health Commercial |
$70.58
|
| Rate for Payer: Humana Commercial |
$63.16
|
| Rate for Payer: Humana KY Medicaid |
$25.55
|
| Rate for Payer: Kentucky WC Medicaid |
$25.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.38
|
| Rate for Payer: Ohio Health Group HMO |
$55.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.03
|
| Rate for Payer: PHCS Commercial |
$71.33
|
| Rate for Payer: United Healthcare All Payer |
$65.38
|
|
|
SODIUM CHLORIDE 0.9% 20mL SDV
|
Facility
|
IP
|
$74.30
|
|
| Hospital Charge Code |
636T0187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$71.33 |
| Rate for Payer: Aetna Commercial |
$57.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.95
|
| Rate for Payer: Cash Price |
$37.15
|
| Rate for Payer: Cigna Commercial |
$61.67
|
| Rate for Payer: First Health Commercial |
$70.58
|
| Rate for Payer: Humana Commercial |
$63.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.38
|
| Rate for Payer: Ohio Health Group HMO |
$55.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.03
|
| Rate for Payer: PHCS Commercial |
$71.33
|
| Rate for Payer: United Healthcare All Payer |
$65.38
|
|
|
SODIUM CHLORIDE 0.9% 20mL SDV
|
Facility
|
OP
|
$74.30
|
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$71.33 |
| Rate for Payer: Aetna Commercial |
$57.21
|
| Rate for Payer: Anthem Medicaid |
$25.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.95
|
| Rate for Payer: Cash Price |
$37.15
|
| Rate for Payer: Cigna Commercial |
$61.67
|
| Rate for Payer: First Health Commercial |
$70.58
|
| Rate for Payer: Humana Commercial |
$63.16
|
| Rate for Payer: Humana KY Medicaid |
$25.55
|
| Rate for Payer: Kentucky WC Medicaid |
$25.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.38
|
| Rate for Payer: Ohio Health Group HMO |
$55.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.03
|
| Rate for Payer: PHCS Commercial |
$71.33
|
| Rate for Payer: United Healthcare All Payer |
$65.38
|
|
|
SODIUM CHLORIDE 0.9% 20mL SDV
|
Facility
|
IP
|
$77.30
|
|
|
Service Code
|
NDC 409488803
|
| Hospital Charge Code |
25004361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$74.21 |
| Rate for Payer: Aetna Commercial |
$59.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.29
|
| Rate for Payer: Cash Price |
$38.65
|
| Rate for Payer: Cigna Commercial |
$64.16
|
| Rate for Payer: First Health Commercial |
$73.44
|
| Rate for Payer: Humana Commercial |
$65.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.02
|
| Rate for Payer: Ohio Health Group HMO |
$57.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.96
|
| Rate for Payer: PHCS Commercial |
$74.21
|
| Rate for Payer: United Healthcare All Payer |
$68.02
|
|
|
SODIUM CHLORIDE 0.9% 250 250ML
|
Facility
|
IP
|
$107.25
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: Aetna Commercial |
$82.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.66
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cigna Commercial |
$89.02
|
| Rate for Payer: First Health Commercial |
$101.89
|
| Rate for Payer: Humana Commercial |
$91.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.38
|
| Rate for Payer: Ohio Health Group HMO |
$80.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.25
|
| Rate for Payer: PHCS Commercial |
$102.96
|
| Rate for Payer: United Healthcare All Payer |
$94.38
|
|
|
SODIUM CHLORIDE 0.9% 250 250ML
|
Facility
|
OP
|
$94.25
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
25003461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$90.48 |
| Rate for Payer: Aetna Commercial |
$72.57
|
| Rate for Payer: Anthem Medicaid |
$32.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.52
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cigna Commercial |
$78.23
|
| Rate for Payer: First Health Commercial |
$89.54
|
| Rate for Payer: Humana Commercial |
$80.11
|
| Rate for Payer: Humana KY Medicaid |
$32.41
|
| Rate for Payer: Kentucky WC Medicaid |
$32.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.94
|
| Rate for Payer: Ohio Health Group HMO |
$70.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.22
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
SODIUM CHLORIDE 0.9% 250 250ML
|
Facility
|
IP
|
$107.25
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
636T0097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: Aetna Commercial |
$82.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.66
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cigna Commercial |
$89.02
|
| Rate for Payer: First Health Commercial |
$101.89
|
| Rate for Payer: Humana Commercial |
$91.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.38
|
| Rate for Payer: Ohio Health Group HMO |
$80.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.25
|
| Rate for Payer: PHCS Commercial |
$102.96
|
| Rate for Payer: United Healthcare All Payer |
$94.38
|
|
|
SODIUM CHLORIDE 0.9% 250 250ML
|
Facility
|
OP
|
$107.25
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: Aetna Commercial |
$82.58
|
| Rate for Payer: Anthem Medicaid |
$36.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.66
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cigna Commercial |
$89.02
|
| Rate for Payer: First Health Commercial |
$101.89
|
| Rate for Payer: Humana Commercial |
$91.16
|
| Rate for Payer: Humana KY Medicaid |
$36.88
|
| Rate for Payer: Kentucky WC Medicaid |
$37.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.38
|
| Rate for Payer: Ohio Health Group HMO |
$80.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.25
|
| Rate for Payer: PHCS Commercial |
$102.96
|
| Rate for Payer: United Healthcare All Payer |
$94.38
|
|
|
SODIUM CHLORIDE 0.9% 250 250ML
|
Professional
|
Both
|
$107.25
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Aetna Commercial |
$0.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.25
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.99
|
| Rate for Payer: Multiplan PHCS |
$64.35
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$75.08
|
| Rate for Payer: UHCCP Medicaid |
$37.54
|
|
|
SODIUM CHLORIDE 0.9% 250 250ML
|
Facility
|
OP
|
$107.25
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
636T0097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: Aetna Commercial |
$82.58
|
| Rate for Payer: Anthem Medicaid |
$36.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.66
|
| Rate for Payer: Cash Price |
$53.62
|
| Rate for Payer: Cigna Commercial |
$89.02
|
| Rate for Payer: First Health Commercial |
$101.89
|
| Rate for Payer: Humana Commercial |
$91.16
|
| Rate for Payer: Humana KY Medicaid |
$36.88
|
| Rate for Payer: Kentucky WC Medicaid |
$37.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.38
|
| Rate for Payer: Ohio Health Group HMO |
$80.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.25
|
| Rate for Payer: PHCS Commercial |
$102.96
|
| Rate for Payer: United Healthcare All Payer |
$94.38
|
|
|
SODIUM CHLORIDE 0.9% 250 250ML
|
Facility
|
IP
|
$94.25
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
25003461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$90.48 |
| Rate for Payer: Aetna Commercial |
$72.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.52
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cigna Commercial |
$78.23
|
| Rate for Payer: First Health Commercial |
$89.54
|
| Rate for Payer: Humana Commercial |
$80.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.94
|
| Rate for Payer: Ohio Health Group HMO |
$70.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.22
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
SODIUM CHLORIDE 0.9% E3 1L BAG
|
Facility
|
OP
|
$66.73
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
25004240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$64.06 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Anthem Medicaid |
$22.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.05
|
| Rate for Payer: Cash Price |
$33.37
|
| Rate for Payer: Cigna Commercial |
$55.39
|
| Rate for Payer: First Health Commercial |
$63.39
|
| Rate for Payer: Humana Commercial |
$56.72
|
| Rate for Payer: Humana KY Medicaid |
$22.95
|
| Rate for Payer: Kentucky WC Medicaid |
$23.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.72
|
| Rate for Payer: Ohio Health Group HMO |
$50.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.69
|
| Rate for Payer: PHCS Commercial |
$64.06
|
| Rate for Payer: United Healthcare All Payer |
$58.72
|
|
|
SODIUM CHLORIDE 0.9% E3 1L BAG
|
Facility
|
IP
|
$66.73
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
25004240
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$64.06 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.05
|
| Rate for Payer: Cash Price |
$33.37
|
| Rate for Payer: Cigna Commercial |
$55.39
|
| Rate for Payer: First Health Commercial |
$63.39
|
| Rate for Payer: Humana Commercial |
$56.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.72
|
| Rate for Payer: Ohio Health Group HMO |
$50.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.69
|
| Rate for Payer: PHCS Commercial |
$64.06
|
| Rate for Payer: United Healthcare All Payer |
$58.72
|
|
|
SODIUM CHLORIDE 0.9% (F 1000ML
|
Facility
|
IP
|
$87.75
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
636T0109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$84.24 |
| Rate for Payer: Aetna Commercial |
$67.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.44
|
| Rate for Payer: Cash Price |
$43.88
|
| Rate for Payer: Cigna Commercial |
$72.83
|
| Rate for Payer: First Health Commercial |
$83.36
|
| Rate for Payer: Humana Commercial |
$74.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.22
|
| Rate for Payer: Ohio Health Group HMO |
$65.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.20
|
| Rate for Payer: PHCS Commercial |
$84.24
|
| Rate for Payer: United Healthcare All Payer |
$77.22
|
|
|
SODIUM CHLORIDE 0.9% (F 1000ML
|
Facility
|
OP
|
$94.25
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
25003457
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$90.48 |
| Rate for Payer: Aetna Commercial |
$72.57
|
| Rate for Payer: Anthem Medicaid |
$32.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.52
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cigna Commercial |
$78.23
|
| Rate for Payer: First Health Commercial |
$89.54
|
| Rate for Payer: Humana Commercial |
$80.11
|
| Rate for Payer: Humana KY Medicaid |
$32.41
|
| Rate for Payer: Kentucky WC Medicaid |
$32.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.94
|
| Rate for Payer: Ohio Health Group HMO |
$70.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.22
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
SODIUM CHLORIDE 0.9% (F 1000ML
|
Facility
|
OP
|
$87.75
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
636T0109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$84.24 |
| Rate for Payer: Aetna Commercial |
$67.57
|
| Rate for Payer: Anthem Medicaid |
$30.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.44
|
| Rate for Payer: Cash Price |
$43.88
|
| Rate for Payer: Cigna Commercial |
$72.83
|
| Rate for Payer: First Health Commercial |
$83.36
|
| Rate for Payer: Humana Commercial |
$74.59
|
| Rate for Payer: Humana KY Medicaid |
$30.18
|
| Rate for Payer: Kentucky WC Medicaid |
$30.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.22
|
| Rate for Payer: Ohio Health Group HMO |
$65.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.20
|
| Rate for Payer: PHCS Commercial |
$84.24
|
| Rate for Payer: United Healthcare All Payer |
$77.22
|
|
|
SODIUM CHLORIDE 0.9% (F 1000ML
|
Facility
|
IP
|
$94.25
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
25003457
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$90.48 |
| Rate for Payer: Aetna Commercial |
$72.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.52
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cigna Commercial |
$78.23
|
| Rate for Payer: First Health Commercial |
$89.54
|
| Rate for Payer: Humana Commercial |
$80.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.94
|
| Rate for Payer: Ohio Health Group HMO |
$70.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.22
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
SODIUM CHLORIDE 0.9% (F 1000ML
|
Professional
|
Both
|
$87.75
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
63600109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.75
|
| Rate for Payer: Cash Price |
$43.88
|
| Rate for Payer: Cash Price |
$43.88
|
| Rate for Payer: Healthspan PPO |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3.96
|
| Rate for Payer: Multiplan PHCS |
$52.65
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$61.42
|
| Rate for Payer: UHCCP Medicaid |
$30.71
|
|
|
SODIUM CHLORIDE 0.9% (F 1000ML
|
Facility
|
OP
|
$87.75
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
63600109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$84.24 |
| Rate for Payer: Aetna Commercial |
$67.57
|
| Rate for Payer: Anthem Medicaid |
$30.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.44
|
| Rate for Payer: Cash Price |
$43.88
|
| Rate for Payer: Cigna Commercial |
$72.83
|
| Rate for Payer: First Health Commercial |
$83.36
|
| Rate for Payer: Humana Commercial |
$74.59
|
| Rate for Payer: Humana KY Medicaid |
$30.18
|
| Rate for Payer: Kentucky WC Medicaid |
$30.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.22
|
| Rate for Payer: Ohio Health Group HMO |
$65.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.20
|
| Rate for Payer: PHCS Commercial |
$84.24
|
| Rate for Payer: United Healthcare All Payer |
$77.22
|
|
|
SODIUM CHLORIDE 0.9% (F 1000ML
|
Facility
|
IP
|
$87.75
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
63600109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$84.24 |
| Rate for Payer: Aetna Commercial |
$67.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.44
|
| Rate for Payer: Cash Price |
$43.88
|
| Rate for Payer: Cigna Commercial |
$72.83
|
| Rate for Payer: First Health Commercial |
$83.36
|
| Rate for Payer: Humana Commercial |
$74.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.22
|
| Rate for Payer: Ohio Health Group HMO |
$65.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.20
|
| Rate for Payer: PHCS Commercial |
$84.24
|
| Rate for Payer: United Healthcare All Payer |
$77.22
|
|
|
SODIUM CHLORIDE 0.9% INHAL 3ML
|
Facility
|
OP
|
$4.48
|
|
|
Service Code
|
NDC 76204030003
|
| Hospital Charge Code |
25001413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.72
|
| Rate for Payer: First Health Commercial |
$4.26
|
| Rate for Payer: Humana Commercial |
$3.81
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.94
|
| Rate for Payer: Ohio Health Group HMO |
$3.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Payer |
$3.94
|
|
