|
SODIUM CHLORIDE 0.9% 10mL SDV
|
Facility
|
IP
|
$77.02
|
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.11 |
| 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 |
$57.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.14
|
| Rate for Payer: PHCS Commercial |
$73.94
|
| Rate for Payer: United Healthcare All Payer |
$67.78
|
|
|
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 |
$23.11 |
| 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 |
$57.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.14
|
| Rate for Payer: PHCS Commercial |
$73.94
|
| Rate for Payer: United Healthcare All Payer |
$67.78
|
|
|
SODIUM CHLORIDE 0.9% 10mL SDV
|
Facility
|
IP
|
$77.02
|
|
| Hospital Charge Code |
636T0110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.11 |
| 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 |
$57.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.14
|
| Rate for Payer: PHCS Commercial |
$73.94
|
| Rate for Payer: United Healthcare All Payer |
$67.78
|
|
|
SODIUM CHLORIDE 0.9% 10mL SDV
|
Facility
|
OP
|
$77.02
|
|
| Hospital Charge Code |
636T0110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.11 |
| 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 |
$57.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.14
|
| Rate for Payer: PHCS Commercial |
$73.94
|
| Rate for Payer: United Healthcare All Payer |
$67.78
|
|
|
SODIUM CHLORIDE 0.9% 10mL SDV
|
Professional
|
Both
|
$77.02
|
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.96 |
| Max. Negotiated Rate |
$53.91 |
| Rate for Payer: Cash Price |
$38.51
|
| Rate for Payer: Multiplan PHCS |
$46.21
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.91
|
| Rate for Payer: UHCCP Medicaid |
$26.96
|
|
|
SODIUM CHLORIDE 0.9% 10mL SDV
|
Facility
|
OP
|
$77.02
|
|
| Hospital Charge Code |
63600110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.11 |
| 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 |
$57.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.14
|
| Rate for Payer: PHCS Commercial |
$73.94
|
| Rate for Payer: United Healthcare All Payer |
$67.78
|
|
|
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 |
$23.11 |
| 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 |
$57.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.14
|
| Rate for Payer: PHCS Commercial |
$73.94
|
| Rate for Payer: United Healthcare All Payer |
$67.78
|
|
|
SODIUM CHLORIDE 0.9% 150ML BAG
|
Facility
|
OP
|
$112.25
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004239
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$33.67 |
| 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 |
$92.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.67
|
| 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 |
$89.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.45
|
| Rate for Payer: PHCS Commercial |
$107.76
|
| Rate for Payer: United Healthcare All Payer |
$98.78
|
|
|
SODIUM CHLORIDE 0.9% 150ML BAG
|
Facility
|
IP
|
$112.25
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004239
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$33.67 |
| 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 |
$92.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.67
|
| 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 |
$89.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.45
|
| Rate for Payer: PHCS Commercial |
$107.76
|
| Rate for Payer: United Healthcare All Payer |
$98.78
|
|
|
SODIUM CHLORIDE 0.9% 20mL SDV
|
Facility
|
IP
|
$77.30
|
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.19 |
| 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 |
$61.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.34
|
| Rate for Payer: PHCS Commercial |
$74.21
|
| Rate for Payer: United Healthcare All Payer |
$68.02
|
|
|
SODIUM CHLORIDE 0.9% 20mL SDV
|
Facility
|
OP
|
$77.30
|
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.19 |
| 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 |
$61.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.34
|
| Rate for Payer: PHCS Commercial |
$74.21
|
| Rate for Payer: United Healthcare All Payer |
$68.02
|
|
|
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 |
$23.19 |
| 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 |
$61.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.34
|
| Rate for Payer: PHCS Commercial |
$74.21
|
| Rate for Payer: United Healthcare All Payer |
$68.02
|
|
|
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 |
$23.19 |
| 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 |
$61.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.34
|
| Rate for Payer: PHCS Commercial |
$74.21
|
| Rate for Payer: United Healthcare All Payer |
$68.02
|
|
|
SODIUM CHLORIDE 0.9% 20mL SDV
|
Facility
|
OP
|
$77.30
|
|
| Hospital Charge Code |
636T0187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.19 |
| 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 |
$61.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.34
|
| Rate for Payer: PHCS Commercial |
$74.21
|
| Rate for Payer: United Healthcare All Payer |
$68.02
|
|
|
SODIUM CHLORIDE 0.9% 20mL SDV
|
Facility
|
IP
|
$77.30
|
|
| Hospital Charge Code |
636T0187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.19 |
| 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 |
$61.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.34
|
| Rate for Payer: PHCS Commercial |
$74.21
|
| Rate for Payer: United Healthcare All Payer |
$68.02
|
|
|
SODIUM CHLORIDE 0.9% 20mL SDV
|
Professional
|
Both
|
$77.30
|
|
| Hospital Charge Code |
63600187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$54.11 |
| Rate for Payer: Cash Price |
$38.65
|
| Rate for Payer: Multiplan PHCS |
$46.38
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.11
|
| Rate for Payer: UHCCP Medicaid |
$27.05
|
|
|
SODIUM CHLORIDE 0.9% 250 250ML
|
Facility
|
IP
|
$94.25
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
636T0097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.27 |
| 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 |
$28.27
|
| 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 |
$75.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.03
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
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 |
$28.27 |
| 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 |
$28.27
|
| 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 |
$75.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.03
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
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 |
$28.27 |
| 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 |
$28.27
|
| 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 |
$75.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.03
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
SODIUM CHLORIDE 0.9% 250 250ML
|
Professional
|
Both
|
$94.25
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$56.55 |
| Rate for Payer: Aetna Commercial |
$0.89
|
| Rate for Payer: Ambetter Exchange |
$0.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.85
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.71
|
| Rate for Payer: Multiplan PHCS |
$56.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.92
|
| Rate for Payer: UHCCP Medicaid |
$32.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.71
|
|
|
SODIUM CHLORIDE 0.9% 250 250ML
|
Facility
|
IP
|
$94.25
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.27 |
| 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 |
$28.27
|
| 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 |
$75.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.03
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
SODIUM CHLORIDE 0.9% 250 250ML
|
Facility
|
OP
|
$94.25
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.27 |
| 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 |
$28.27
|
| 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 |
$75.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.03
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
SODIUM CHLORIDE 0.9% 250 250ML
|
Facility
|
OP
|
$94.25
|
|
|
Service Code
|
HCPCS J7050
|
| Hospital Charge Code |
636T0097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.27 |
| 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 |
$28.27
|
| 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 |
$75.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.03
|
| Rate for Payer: PHCS Commercial |
$90.48
|
| Rate for Payer: United Healthcare All Payer |
$82.94
|
|
|
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 |
$20.02 |
| 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 |
$53.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.04
|
| Rate for Payer: PHCS Commercial |
$64.06
|
| Rate for Payer: United Healthcare All Payer |
$58.72
|
|
|
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 |
$20.02 |
| 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 |
$53.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.04
|
| Rate for Payer: PHCS Commercial |
$64.06
|
| Rate for Payer: United Healthcare All Payer |
$58.72
|
|
