|
CALCIMAR (CALCITONIN 400IU/2ML
|
Facility
|
OP
|
$4,881.00
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
25001914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$634.53 |
| Max. Negotiated Rate |
$4,685.76 |
| Rate for Payer: Aetna Commercial |
$3,758.37
|
| Rate for Payer: Anthem Medicaid |
$1,678.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,069.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,497.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,443.82
|
| Rate for Payer: Cash Price |
$2,440.50
|
| Rate for Payer: Cash Price |
$2,440.50
|
| Rate for Payer: Cigna Commercial |
$4,051.23
|
| Rate for Payer: First Health Commercial |
$4,636.95
|
| Rate for Payer: Humana Commercial |
$4,148.85
|
| Rate for Payer: Humana KY Medicaid |
$1,678.58
|
| Rate for Payer: Humana Medicare Advantage |
$1,069.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,695.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,002.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,283.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,712.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,295.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,660.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.11
|
| Rate for Payer: PHCS Commercial |
$4,685.76
|
| Rate for Payer: United Healthcare All Payer |
$4,295.28
|
|
|
CALCIUM CHLORIDE10%1000MG/10ML
|
Facility
|
OP
|
$127.22
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$122.13 |
| Rate for Payer: Aetna Commercial |
$97.96
|
| Rate for Payer: Anthem Medicaid |
$43.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.23
|
| Rate for Payer: Cash Price |
$63.61
|
| Rate for Payer: Cigna Commercial |
$105.59
|
| Rate for Payer: First Health Commercial |
$120.86
|
| Rate for Payer: Humana Commercial |
$108.14
|
| Rate for Payer: Humana KY Medicaid |
$43.75
|
| Rate for Payer: Kentucky WC Medicaid |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.95
|
| Rate for Payer: Ohio Health Group HMO |
$95.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.44
|
| Rate for Payer: PHCS Commercial |
$122.13
|
| Rate for Payer: United Healthcare All Payer |
$111.95
|
|
|
CALCIUM CHLORIDE10%1000MG/10ML
|
Facility
|
IP
|
$127.22
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$122.13 |
| Rate for Payer: Aetna Commercial |
$97.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.23
|
| Rate for Payer: Cash Price |
$63.61
|
| Rate for Payer: Cigna Commercial |
$105.59
|
| Rate for Payer: First Health Commercial |
$120.86
|
| Rate for Payer: Humana Commercial |
$108.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.95
|
| Rate for Payer: Ohio Health Group HMO |
$95.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.44
|
| Rate for Payer: PHCS Commercial |
$122.13
|
| Rate for Payer: United Healthcare All Payer |
$111.95
|
|
|
CALCIUM CHLORIDE 13.6MEQ/10ML
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
NDC 76329330401
|
| Hospital Charge Code |
25002920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Aetna Commercial |
$90.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.65
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: First Health Commercial |
$111.62
|
| Rate for Payer: Humana Commercial |
$99.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.40
|
| Rate for Payer: Ohio Health Group HMO |
$88.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.42
|
| Rate for Payer: PHCS Commercial |
$112.80
|
| Rate for Payer: United Healthcare All Payer |
$103.40
|
|
|
CALCIUM CHLORIDE 13.6MEQ/10ML
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
NDC 76329330401
|
| Hospital Charge Code |
25002920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Aetna Commercial |
$90.48
|
| Rate for Payer: Anthem Medicaid |
$40.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.65
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: First Health Commercial |
$111.62
|
| Rate for Payer: Humana Commercial |
$99.88
|
| Rate for Payer: Humana KY Medicaid |
$40.41
|
| Rate for Payer: Kentucky WC Medicaid |
$40.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.40
|
| Rate for Payer: Ohio Health Group HMO |
$88.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.42
|
| Rate for Payer: PHCS Commercial |
$112.80
|
| Rate for Payer: United Healthcare All Payer |
$103.40
|
|
|
CALCIUM CHLORIDE 13.6MEQ/10ML
|
Facility
|
OP
|
$127.22
|
|
|
Service Code
|
NDC 517671001
|
| Hospital Charge Code |
25002919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$122.13 |
| Rate for Payer: Aetna Commercial |
$97.96
|
| Rate for Payer: Anthem Medicaid |
$43.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.23
|
| Rate for Payer: Cash Price |
$63.61
|
| Rate for Payer: Cigna Commercial |
$105.59
|
| Rate for Payer: First Health Commercial |
$120.86
|
| Rate for Payer: Humana Commercial |
$108.14
|
| Rate for Payer: Humana KY Medicaid |
$43.75
|
| Rate for Payer: Kentucky WC Medicaid |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.95
|
| Rate for Payer: Ohio Health Group HMO |
$95.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.44
|
| Rate for Payer: PHCS Commercial |
$122.13
|
| Rate for Payer: United Healthcare All Payer |
$111.95
|
|
|
CALCIUM CHLORIDE 13.6MEQ/10ML
|
Facility
|
IP
|
$127.22
|
|
|
Service Code
|
NDC 517671001
|
| Hospital Charge Code |
25002919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$122.13 |
| Rate for Payer: Aetna Commercial |
$97.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.23
|
| Rate for Payer: Cash Price |
$63.61
|
| Rate for Payer: Cigna Commercial |
$105.59
|
| Rate for Payer: First Health Commercial |
$120.86
|
| Rate for Payer: Humana Commercial |
$108.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.95
|
| Rate for Payer: Ohio Health Group HMO |
$95.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.44
|
| Rate for Payer: PHCS Commercial |
$122.13
|
| Rate for Payer: United Healthcare All Payer |
$111.95
|
|
|
CALCIUM GLUC 10MG (1GM PREMIX)
|
Facility
|
OP
|
$69.11
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
25004230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$66.35 |
| Rate for Payer: Aetna Commercial |
$53.21
|
| Rate for Payer: Anthem Medicaid |
$23.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.11
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cigna Commercial |
$57.36
|
| Rate for Payer: First Health Commercial |
$65.65
|
| Rate for Payer: Humana Commercial |
$58.74
|
| Rate for Payer: Humana KY Medicaid |
$23.77
|
| Rate for Payer: Humana Medicare Advantage |
$0.08
|
| Rate for Payer: Kentucky WC Medicaid |
$24.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.82
|
| Rate for Payer: Ohio Health Group HMO |
$51.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.42
|
| Rate for Payer: PHCS Commercial |
$66.35
|
| Rate for Payer: United Healthcare All Payer |
$60.82
|
|
|
CALCIUM GLUC 10MG (1GM PREMIX)
|
Facility
|
IP
|
$69.11
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
25004230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$66.35 |
| Rate for Payer: Aetna Commercial |
$53.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.91
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cigna Commercial |
$57.36
|
| Rate for Payer: First Health Commercial |
$65.65
|
| Rate for Payer: Humana Commercial |
$58.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.82
|
| Rate for Payer: Ohio Health Group HMO |
$51.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.42
|
| Rate for Payer: PHCS Commercial |
$66.35
|
| Rate for Payer: United Healthcare All Payer |
$60.82
|
|
|
CALCIUM GLUC 10MG (1GM SDV)
|
Facility
|
OP
|
$54.61
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
25001913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$42.05
|
| Rate for Payer: Anthem Medicaid |
$18.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.07
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: First Health Commercial |
$51.88
|
| Rate for Payer: Humana Commercial |
$46.42
|
| Rate for Payer: Humana KY Medicaid |
$18.78
|
| Rate for Payer: Humana Medicare Advantage |
$0.05
|
| Rate for Payer: Kentucky WC Medicaid |
$18.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.06
|
| Rate for Payer: Ohio Health Group HMO |
$40.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.93
|
| Rate for Payer: PHCS Commercial |
$52.43
|
| Rate for Payer: United Healthcare All Payer |
$48.06
|
|
|
CALCIUM GLUC 10MG (1GM SDV)
|
Facility
|
IP
|
$54.61
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
25001913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$42.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.60
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: First Health Commercial |
$51.88
|
| Rate for Payer: Humana Commercial |
$46.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.06
|
| Rate for Payer: Ohio Health Group HMO |
$40.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.93
|
| Rate for Payer: PHCS Commercial |
$52.43
|
| Rate for Payer: United Healthcare All Payer |
$48.06
|
|
|
CALCIUM GLUC 10MG(4.6mEqPREMX)
|
Facility
|
OP
|
$69.11
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
25004388
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$66.35 |
| Rate for Payer: Aetna Commercial |
$53.21
|
| Rate for Payer: Anthem Medicaid |
$23.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.11
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cigna Commercial |
$57.36
|
| Rate for Payer: First Health Commercial |
$65.65
|
| Rate for Payer: Humana Commercial |
$58.74
|
| Rate for Payer: Humana KY Medicaid |
$23.77
|
| Rate for Payer: Humana Medicare Advantage |
$0.08
|
| Rate for Payer: Kentucky WC Medicaid |
$24.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.82
|
| Rate for Payer: Ohio Health Group HMO |
$51.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.42
|
| Rate for Payer: PHCS Commercial |
$66.35
|
| Rate for Payer: United Healthcare All Payer |
$60.82
|
|
|
CALCIUM GLUC 10MG(4.6mEqPREMX)
|
Facility
|
IP
|
$69.11
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
25004388
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$66.35 |
| Rate for Payer: Aetna Commercial |
$53.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.91
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cigna Commercial |
$57.36
|
| Rate for Payer: First Health Commercial |
$65.65
|
| Rate for Payer: Humana Commercial |
$58.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.82
|
| Rate for Payer: Ohio Health Group HMO |
$51.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.42
|
| Rate for Payer: PHCS Commercial |
$66.35
|
| Rate for Payer: United Healthcare All Payer |
$60.82
|
|
|
CALCIUM GLUC 10MG(4.6mEq SDV)
|
Facility
|
OP
|
$54.61
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
25004387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$42.05
|
| Rate for Payer: Anthem Medicaid |
$18.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.07
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: First Health Commercial |
$51.88
|
| Rate for Payer: Humana Commercial |
$46.42
|
| Rate for Payer: Humana KY Medicaid |
$18.78
|
| Rate for Payer: Humana Medicare Advantage |
$0.05
|
| Rate for Payer: Kentucky WC Medicaid |
$18.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.06
|
| Rate for Payer: Ohio Health Group HMO |
$40.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.93
|
| Rate for Payer: PHCS Commercial |
$52.43
|
| Rate for Payer: United Healthcare All Payer |
$48.06
|
|
|
CALCIUM GLUC 10MG(4.6mEq SDV)
|
Facility
|
IP
|
$54.61
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
25004387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Humana Commercial |
$46.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.06
|
| Rate for Payer: Ohio Health Group HMO |
$40.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.93
|
| Rate for Payer: PHCS Commercial |
$52.43
|
| Rate for Payer: United Healthcare All Payer |
$48.06
|
| Rate for Payer: Aetna Commercial |
$42.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.60
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: First Health Commercial |
$51.88
|
|
|
CALCIUM GLUCONATE 23MEQ/50ML
|
Facility
|
IP
|
$182.98
|
|
|
Service Code
|
NDC 63323036059
|
| Hospital Charge Code |
25003806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Aetna Commercial |
$140.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.72
|
| Rate for Payer: Cash Price |
$91.49
|
| Rate for Payer: Cigna Commercial |
$151.87
|
| Rate for Payer: First Health Commercial |
$173.83
|
| Rate for Payer: Humana Commercial |
$155.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.02
|
| Rate for Payer: Ohio Health Group HMO |
$137.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.72
|
| Rate for Payer: PHCS Commercial |
$175.66
|
| Rate for Payer: United Healthcare All Payer |
$161.02
|
|
|
CALCIUM GLUCONATE 23MEQ/50ML
|
Facility
|
OP
|
$182.98
|
|
|
Service Code
|
NDC 63323036059
|
| Hospital Charge Code |
25003806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$175.66 |
| Rate for Payer: Aetna Commercial |
$140.89
|
| Rate for Payer: Anthem Medicaid |
$62.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.72
|
| Rate for Payer: Cash Price |
$91.49
|
| Rate for Payer: Cigna Commercial |
$151.87
|
| Rate for Payer: First Health Commercial |
$173.83
|
| Rate for Payer: Humana Commercial |
$155.53
|
| Rate for Payer: Humana KY Medicaid |
$62.93
|
| Rate for Payer: Kentucky WC Medicaid |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.02
|
| Rate for Payer: Ohio Health Group HMO |
$137.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.72
|
| Rate for Payer: PHCS Commercial |
$175.66
|
| Rate for Payer: United Healthcare All Payer |
$161.02
|
|
|
CALCIUM SERUM
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
30000259
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem Medicaid |
$5.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.16
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Humana KY Medicaid |
$5.16
|
| Rate for Payer: Humana Medicare Advantage |
$5.16
|
| Rate for Payer: Kentucky WC Medicaid |
$5.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
CALCIUM SERUM
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
30000259
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
CALCULUS (STONE) ANALYSIS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 82355
|
| Hospital Charge Code |
30001571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$57.00
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$10.31
|
| Rate for Payer: Healthspan PPO |
$9.17
|
| Rate for Payer: Multiplan PHCS |
$34.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.90
|
| Rate for Payer: UHCCP Medicaid |
$19.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$6.95
|
|
|
CALCULUS (STONE) ANALYSIS
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 82355
|
| Hospital Charge Code |
30001571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem Medicaid |
$11.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.58
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Humana KY Medicaid |
$11.58
|
| Rate for Payer: Humana Medicare Advantage |
$11.58
|
| Rate for Payer: Kentucky WC Medicaid |
$11.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
CALCULUS (STONE) ANALYSIS
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 82355
|
| Hospital Charge Code |
30001571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
CALIBRATED DRILL 6.2M*48.2C
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
CALIBRATED DRILL 6.2M*48.2C
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
CALIBRATED TAP 3.5MM
|
Facility
|
IP
|
$3,104.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.53 |
| Max. Negotiated Rate |
$2,979.89 |
| Rate for Payer: Aetna Commercial |
$2,390.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,421.16
|
| Rate for Payer: Cash Price |
$1,552.03
|
| Rate for Payer: Cigna Commercial |
$2,576.36
|
| Rate for Payer: First Health Commercial |
$2,948.85
|
| Rate for Payer: Humana Commercial |
$2,638.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,545.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,731.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,328.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$962.26
|
| Rate for Payer: PHCS Commercial |
$2,979.89
|
| Rate for Payer: United Healthcare All Payer |
$2,731.56
|
|
