|
SODIUM CHLORIDE 0.9% (F 1000ML
|
Facility
|
IP
|
$94.25
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
636T0109
|
|
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% (F 1000ML
|
Facility
|
OP
|
$94.25
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
63600109
|
|
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% (F 1000ML
|
Facility
|
IP
|
$94.25
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
25003457
|
|
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% (F 1000ML
|
Facility
|
IP
|
$94.25
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
63600109
|
|
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% (F 1000ML
|
Professional
|
Both
|
$94.25
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
63600109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$56.55 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Ambetter Exchange |
$2.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.74
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Cash Price |
$47.12
|
| Rate for Payer: Healthspan PPO |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.28
|
| Rate for Payer: Multiplan PHCS |
$56.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.96
|
| Rate for Payer: UHCCP Medicaid |
$32.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.28
|
|
|
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 |
$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% (F 1000ML
|
Facility
|
OP
|
$94.25
|
|
|
Service Code
|
HCPCS J7030
|
| Hospital Charge Code |
636T0109
|
|
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% INHAL 3ML
|
Facility
|
OP
|
$4.48
|
|
|
Service Code
|
NDC 76204030003
|
| Hospital Charge Code |
25001413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| 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 |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.09
|
| Rate for Payer: PHCS Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Payer |
$3.94
|
|
|
SODIUM CHLORIDE 0.9% INHAL 3ML
|
Facility
|
IP
|
$4.48
|
|
|
Service Code
|
NDC 76204030003
|
| Hospital Charge Code |
25001413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Aetna Commercial |
$3.45
|
| 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: 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: Ohio Health Choice Commercial |
$3.94
|
| Rate for Payer: Ohio Health Group HMO |
$3.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.09
|
| Rate for Payer: PHCS Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Payer |
$3.94
|
|
|
SODIUM CHLORIDE 0.9% (IV 107ML
|
Facility
|
IP
|
$92.04
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003458
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$27.61 |
| Max. Negotiated Rate |
$88.36 |
| Rate for Payer: Aetna Commercial |
$70.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.79
|
| Rate for Payer: Cash Price |
$46.02
|
| Rate for Payer: Cigna Commercial |
$76.39
|
| Rate for Payer: First Health Commercial |
$87.44
|
| Rate for Payer: Humana Commercial |
$78.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.00
|
| Rate for Payer: Ohio Health Group HMO |
$69.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.51
|
| Rate for Payer: PHCS Commercial |
$88.36
|
| Rate for Payer: United Healthcare All Payer |
$81.00
|
|
|
SODIUM CHLORIDE 0.9% (IV 107ML
|
Facility
|
OP
|
$92.04
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003458
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$27.61 |
| Max. Negotiated Rate |
$88.36 |
| Rate for Payer: Aetna Commercial |
$70.87
|
| Rate for Payer: Anthem Medicaid |
$31.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.79
|
| Rate for Payer: Cash Price |
$46.02
|
| Rate for Payer: Cigna Commercial |
$76.39
|
| Rate for Payer: First Health Commercial |
$87.44
|
| Rate for Payer: Humana Commercial |
$78.23
|
| Rate for Payer: Humana KY Medicaid |
$31.65
|
| Rate for Payer: Kentucky WC Medicaid |
$31.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.00
|
| Rate for Payer: Ohio Health Group HMO |
$69.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.51
|
| Rate for Payer: PHCS Commercial |
$88.36
|
| Rate for Payer: United Healthcare All Payer |
$81.00
|
|
|
SODIUM CHLORIDE 0.9% (IV 500ML
|
Facility
|
OP
|
$94.25
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
25003459
|
|
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% (IV 500ML
|
Facility
|
IP
|
$94.25
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
25003459
|
|
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% (IVP 56ML
|
Facility
|
IP
|
$91.97
|
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$88.29 |
| Rate for Payer: Aetna Commercial |
$70.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.74
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cigna Commercial |
$76.34
|
| Rate for Payer: First Health Commercial |
$87.37
|
| Rate for Payer: Humana Commercial |
$78.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.93
|
| Rate for Payer: Ohio Health Group HMO |
$68.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.46
|
| Rate for Payer: PHCS Commercial |
$88.29
|
| Rate for Payer: United Healthcare All Payer |
$80.93
|
|
|
SODIUM CHLORIDE 0.9% (IVP 56ML
|
Facility
|
OP
|
$91.97
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003460
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$88.29 |
| Rate for Payer: Aetna Commercial |
$70.82
|
| Rate for Payer: Anthem Medicaid |
$31.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.74
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cigna Commercial |
$76.34
|
| Rate for Payer: First Health Commercial |
$87.37
|
| Rate for Payer: Humana Commercial |
$78.17
|
| Rate for Payer: Humana KY Medicaid |
$31.63
|
| Rate for Payer: Kentucky WC Medicaid |
$31.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.93
|
| Rate for Payer: Ohio Health Group HMO |
$68.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.46
|
| Rate for Payer: PHCS Commercial |
$88.29
|
| Rate for Payer: United Healthcare All Payer |
$80.93
|
|
|
SODIUM CHLORIDE 0.9% (IVP 56ML
|
Facility
|
OP
|
$91.97
|
|
| Hospital Charge Code |
636T0096
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$88.29 |
| Rate for Payer: Aetna Commercial |
$70.82
|
| Rate for Payer: Anthem Medicaid |
$31.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.74
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cigna Commercial |
$76.34
|
| Rate for Payer: First Health Commercial |
$87.37
|
| Rate for Payer: Humana Commercial |
$78.17
|
| Rate for Payer: Humana KY Medicaid |
$31.63
|
| Rate for Payer: Kentucky WC Medicaid |
$31.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.93
|
| Rate for Payer: Ohio Health Group HMO |
$68.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.46
|
| Rate for Payer: PHCS Commercial |
$88.29
|
| Rate for Payer: United Healthcare All Payer |
$80.93
|
|
|
SODIUM CHLORIDE 0.9% (IVP 56ML
|
Professional
|
Both
|
$91.97
|
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$64.38 |
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Multiplan PHCS |
$55.18
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.38
|
| Rate for Payer: UHCCP Medicaid |
$32.19
|
|
|
SODIUM CHLORIDE 0.9% (IVP 56ML
|
Facility
|
OP
|
$91.97
|
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$88.29 |
| Rate for Payer: Aetna Commercial |
$70.82
|
| Rate for Payer: Anthem Medicaid |
$31.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.74
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cigna Commercial |
$76.34
|
| Rate for Payer: First Health Commercial |
$87.37
|
| Rate for Payer: Humana Commercial |
$78.17
|
| Rate for Payer: Humana KY Medicaid |
$31.63
|
| Rate for Payer: Kentucky WC Medicaid |
$31.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.93
|
| Rate for Payer: Ohio Health Group HMO |
$68.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.46
|
| Rate for Payer: PHCS Commercial |
$88.29
|
| Rate for Payer: United Healthcare All Payer |
$80.93
|
|
|
SODIUM CHLORIDE 0.9% (IVP 56ML
|
Facility
|
IP
|
$91.97
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003460
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$88.29 |
| Rate for Payer: Aetna Commercial |
$70.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.74
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cigna Commercial |
$76.34
|
| Rate for Payer: First Health Commercial |
$87.37
|
| Rate for Payer: Humana Commercial |
$78.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.93
|
| Rate for Payer: Ohio Health Group HMO |
$68.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.46
|
| Rate for Payer: PHCS Commercial |
$88.29
|
| Rate for Payer: United Healthcare All Payer |
$80.93
|
|
|
SODIUM CHLORIDE 0.9% (IVP 56ML
|
Facility
|
IP
|
$91.97
|
|
| Hospital Charge Code |
636T0096
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$88.29 |
| Rate for Payer: Aetna Commercial |
$70.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.74
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cigna Commercial |
$76.34
|
| Rate for Payer: First Health Commercial |
$87.37
|
| Rate for Payer: Humana Commercial |
$78.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.93
|
| Rate for Payer: Ohio Health Group HMO |
$68.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.46
|
| Rate for Payer: PHCS Commercial |
$88.29
|
| Rate for Payer: United Healthcare All Payer |
$80.93
|
|
|
SODIUM CHLORIDE 2920MG/20ML
|
Facility
|
IP
|
$113.70
|
|
|
Service Code
|
NDC 409666075
|
| Hospital Charge Code |
25003455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$109.15 |
| Rate for Payer: Aetna Commercial |
$87.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.69
|
| Rate for Payer: Cash Price |
$56.85
|
| Rate for Payer: Cigna Commercial |
$94.37
|
| Rate for Payer: First Health Commercial |
$108.02
|
| Rate for Payer: Humana Commercial |
$96.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.06
|
| Rate for Payer: Ohio Health Group HMO |
$85.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.45
|
| Rate for Payer: PHCS Commercial |
$109.15
|
| Rate for Payer: United Healthcare All Payer |
$100.06
|
|
|
SODIUM CHLORIDE 2920MG/20ML
|
Facility
|
OP
|
$113.70
|
|
|
Service Code
|
NDC 409666075
|
| Hospital Charge Code |
25003455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$109.15 |
| Rate for Payer: Aetna Commercial |
$87.55
|
| Rate for Payer: Anthem Medicaid |
$39.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.69
|
| Rate for Payer: Cash Price |
$56.85
|
| Rate for Payer: Cigna Commercial |
$94.37
|
| Rate for Payer: First Health Commercial |
$108.02
|
| Rate for Payer: Humana Commercial |
$96.64
|
| Rate for Payer: Humana KY Medicaid |
$39.10
|
| Rate for Payer: Kentucky WC Medicaid |
$39.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.06
|
| Rate for Payer: Ohio Health Group HMO |
$85.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.45
|
| Rate for Payer: PHCS Commercial |
$109.15
|
| Rate for Payer: United Healthcare All Payer |
$100.06
|
|
|
SODIUM CHLORIDE 3% 500ML
|
Facility
|
IP
|
$95.35
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25003465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$91.54 |
| Rate for Payer: Aetna Commercial |
$73.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.37
|
| Rate for Payer: Cash Price |
$47.67
|
| Rate for Payer: Cigna Commercial |
$79.14
|
| Rate for Payer: First Health Commercial |
$90.58
|
| Rate for Payer: Humana Commercial |
$81.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.91
|
| Rate for Payer: Ohio Health Group HMO |
$71.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.79
|
| Rate for Payer: PHCS Commercial |
$91.54
|
| Rate for Payer: United Healthcare All Payer |
$83.91
|
|
|
SODIUM CHLORIDE 3% 500ML
|
Facility
|
OP
|
$95.35
|
|
|
Service Code
|
HCPCS J7131
|
| Hospital Charge Code |
25003465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$91.54 |
| Rate for Payer: Aetna Commercial |
$73.42
|
| Rate for Payer: Anthem Medicaid |
$32.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.37
|
| Rate for Payer: Cash Price |
$47.67
|
| Rate for Payer: Cigna Commercial |
$79.14
|
| Rate for Payer: First Health Commercial |
$90.58
|
| Rate for Payer: Humana Commercial |
$81.05
|
| Rate for Payer: Humana KY Medicaid |
$32.79
|
| Rate for Payer: Kentucky WC Medicaid |
$33.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.91
|
| Rate for Payer: Ohio Health Group HMO |
$71.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.79
|
| Rate for Payer: PHCS Commercial |
$91.54
|
| Rate for Payer: United Healthcare All Payer |
$83.91
|
|
|
SODIUM CHLORIDE 50 ML VIAL
|
Facility
|
OP
|
$79.21
|
|
| Hospital Charge Code |
636T0098
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$76.04 |
| Rate for Payer: Aetna Commercial |
$60.99
|
| 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 |
$75.25
|
| Rate for Payer: Humana Commercial |
$67.33
|
| Rate for Payer: Humana KY Medicaid |
$27.24
|
| Rate for Payer: Kentucky WC Medicaid |
$27.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.70
|
| Rate for Payer: Ohio Health Group HMO |
$59.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.65
|
| Rate for Payer: PHCS Commercial |
$76.04
|
| Rate for Payer: United Healthcare All Payer |
$69.70
|
|
