|
CAFFEINE CITRATE5MG 20MG/ML VL
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
25001954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$121.92 |
| Rate for Payer: Aetna Commercial |
$97.79
|
| Rate for Payer: Anthem Medicaid |
$43.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.06
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$105.41
|
| Rate for Payer: First Health Commercial |
$120.65
|
| Rate for Payer: Humana Commercial |
$107.95
|
| Rate for Payer: Humana KY Medicaid |
$43.68
|
| Rate for Payer: Kentucky WC Medicaid |
$44.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.76
|
| Rate for Payer: Ohio Health Group HMO |
$95.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.63
|
| Rate for Payer: PHCS Commercial |
$121.92
|
| Rate for Payer: United Healthcare All Payer |
$111.76
|
|
|
CAFFEINE CITRATE5MG 20MG/ML VL
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
25001954
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$121.92 |
| Rate for Payer: Aetna Commercial |
$97.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.06
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$105.41
|
| Rate for Payer: First Health Commercial |
$120.65
|
| Rate for Payer: Humana Commercial |
$107.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.76
|
| Rate for Payer: Ohio Health Group HMO |
$95.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.63
|
| Rate for Payer: PHCS Commercial |
$121.92
|
| Rate for Payer: United Healthcare All Payer |
$111.76
|
|
|
CAFFEINE&NABENZOAT 500MG/2ML V
|
Facility
|
IP
|
$185.61
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002915
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$178.19 |
| Rate for Payer: Aetna Commercial |
$142.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$144.78
|
| Rate for Payer: Cash Price |
$92.81
|
| Rate for Payer: Cigna Commercial |
$154.06
|
| Rate for Payer: First Health Commercial |
$176.33
|
| Rate for Payer: Humana Commercial |
$157.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.34
|
| Rate for Payer: Ohio Health Group HMO |
$139.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.07
|
| Rate for Payer: PHCS Commercial |
$178.19
|
| Rate for Payer: United Healthcare All Payer |
$163.34
|
|
|
CAFFEINE&NABENZOAT 500MG/2ML V
|
Facility
|
OP
|
$185.61
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002915
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$178.19 |
| Rate for Payer: Aetna Commercial |
$142.92
|
| Rate for Payer: Anthem Medicaid |
$63.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$144.78
|
| Rate for Payer: Cash Price |
$92.81
|
| Rate for Payer: Cigna Commercial |
$154.06
|
| Rate for Payer: First Health Commercial |
$176.33
|
| Rate for Payer: Humana Commercial |
$157.77
|
| Rate for Payer: Humana KY Medicaid |
$63.83
|
| Rate for Payer: Kentucky WC Medicaid |
$64.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.34
|
| Rate for Payer: Ohio Health Group HMO |
$139.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.07
|
| Rate for Payer: PHCS Commercial |
$178.19
|
| Rate for Payer: United Healthcare All Payer |
$163.34
|
|
|
CALADRYL (CALAMINE/DIPHEN) 6OZ
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 904253321
|
| Hospital Charge Code |
25000361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna Commercial |
$0.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna Commercial |
$0.09
|
| Rate for Payer: First Health Commercial |
$0.10
|
| Rate for Payer: Humana Commercial |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.10
|
| Rate for Payer: Ohio Health Group HMO |
$0.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.08
|
| Rate for Payer: PHCS Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Payer |
$0.10
|
|
|
CALADRYL (CALAMINE/DIPHEN) 6OZ
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 904253321
|
| Hospital Charge Code |
25000361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna Commercial |
$0.08
|
| Rate for Payer: Anthem Medicaid |
$0.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.09
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna Commercial |
$0.09
|
| Rate for Payer: First Health Commercial |
$0.10
|
| Rate for Payer: Humana Commercial |
$0.09
|
| Rate for Payer: Humana KY Medicaid |
$0.04
|
| Rate for Payer: Kentucky WC Medicaid |
$0.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.10
|
| Rate for Payer: Ohio Health Group HMO |
$0.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.08
|
| Rate for Payer: PHCS Commercial |
$0.11
|
| Rate for Payer: United Healthcare All Payer |
$0.10
|
|
|
CALAN SR 120 MG TABLET
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
25000362
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.56
|
| Rate for Payer: Humana Commercial |
$4.08
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| Rate for Payer: PHCS Commercial |
$4.61
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
CALAN SR 120 MG TABLET
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
NDC 68462029201
|
| Hospital Charge Code |
25000362
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.56
|
| Rate for Payer: Humana Commercial |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| Rate for Payer: PHCS Commercial |
$4.61
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
CALAN (VERAPAMIL) 5MG/ 5MG/2ML
|
Facility
|
OP
|
$185.38
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002917
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$55.61 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$142.74
|
| Rate for Payer: Anthem Medicaid |
$63.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$144.60
|
| Rate for Payer: Cash Price |
$92.69
|
| Rate for Payer: Cigna Commercial |
$153.87
|
| Rate for Payer: First Health Commercial |
$176.11
|
| Rate for Payer: Humana Commercial |
$157.57
|
| Rate for Payer: Humana KY Medicaid |
$63.75
|
| Rate for Payer: Kentucky WC Medicaid |
$64.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.13
|
| Rate for Payer: Ohio Health Group HMO |
$139.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.91
|
| Rate for Payer: PHCS Commercial |
$177.96
|
| Rate for Payer: United Healthcare All Payer |
$163.13
|
|
|
CALAN (VERAPAMIL) 5MG/ 5MG/2ML
|
Facility
|
IP
|
$185.38
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002917
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$55.61 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$142.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$144.60
|
| Rate for Payer: Cash Price |
$92.69
|
| Rate for Payer: Cigna Commercial |
$153.87
|
| Rate for Payer: First Health Commercial |
$176.11
|
| Rate for Payer: Humana Commercial |
$157.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.13
|
| Rate for Payer: Ohio Health Group HMO |
$139.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.91
|
| Rate for Payer: PHCS Commercial |
$177.96
|
| Rate for Payer: United Healthcare All Payer |
$163.13
|
|
|
CALCIMAR (CALCITONIN 400IU/2ML
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
25001914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$522.60 |
| Max. Negotiated Rate |
$1,672.32 |
| Rate for Payer: Aetna Commercial |
$1,341.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,358.76
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cigna Commercial |
$1,445.86
|
| Rate for Payer: First Health Commercial |
$1,654.90
|
| Rate for Payer: Humana Commercial |
$1,480.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,428.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,285.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,532.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,306.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,393.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,515.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,201.98
|
| Rate for Payer: PHCS Commercial |
$1,672.32
|
| Rate for Payer: United Healthcare All Payer |
$1,532.96
|
|
|
CALCIMAR (CALCITONIN 400IU/2ML
|
Facility
|
OP
|
$1,742.00
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
25001914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$599.07 |
| Max. Negotiated Rate |
$1,672.32 |
| Rate for Payer: Aetna Commercial |
$1,341.34
|
| Rate for Payer: Anthem Medicaid |
$599.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$835.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,358.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,170.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,128.33
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cigna Commercial |
$1,445.86
|
| Rate for Payer: First Health Commercial |
$1,654.90
|
| Rate for Payer: Humana Commercial |
$1,480.70
|
| Rate for Payer: Humana KY Medicaid |
$599.07
|
| Rate for Payer: Humana Medicare Advantage |
$835.80
|
| Rate for Payer: Kentucky WC Medicaid |
$605.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,428.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,285.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$611.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,532.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,306.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,393.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,515.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,201.98
|
| Rate for Payer: PHCS Commercial |
$1,672.32
|
| Rate for Payer: United Healthcare All Payer |
$1,532.96
|
|
|
CALCIUM CHLORIDE10%1000MG/10ML
|
Facility
|
OP
|
$127.22
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003919
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$38.17 |
| 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 |
$101.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.78
|
| 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
|
890
|
| Min. Negotiated Rate |
$38.17 |
| 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 |
$101.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.78
|
| 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 |
$35.25 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Aetna Commercial |
$90.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.65
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cigna Commercial |
$97.53
|
| 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 |
$94.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.08
|
| Rate for Payer: PHCS Commercial |
$112.80
|
| Rate for Payer: United Healthcare All Payer |
$103.40
|
|
|
CALCIUM CHLORIDE 13.6MEQ/10ML
|
Facility
|
IP
|
$127.22
|
|
|
Service Code
|
NDC 517671001
|
| Hospital Charge Code |
25002919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.17 |
| 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 |
$101.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.78
|
| Rate for Payer: PHCS Commercial |
$122.13
|
| Rate for Payer: United Healthcare All Payer |
$111.95
|
|
|
CALCIUM CHLORIDE 13.6MEQ/10ML
|
Facility
|
OP
|
$127.22
|
|
|
Service Code
|
NDC 517671001
|
| Hospital Charge Code |
25002919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.17 |
| 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 |
$101.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.78
|
| Rate for Payer: PHCS Commercial |
$122.13
|
| Rate for Payer: United Healthcare All Payer |
$111.95
|
|
|
CALCIUM CHLORIDE 13.6MEQ/10ML
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
NDC 76329330401
|
| Hospital Charge Code |
25002920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$112.80 |
| Rate for Payer: Aetna Commercial |
$90.47
|
| 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 |
$97.53
|
| 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 |
$94.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.08
|
| Rate for Payer: PHCS Commercial |
$112.80
|
| Rate for Payer: United Healthcare All Payer |
$103.40
|
|
|
CALCIUM GLUC 10MG (1GM PREMIX)
|
Facility
|
IP
|
$69.11
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
25004230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.73 |
| 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 |
$55.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.69
|
| Rate for Payer: PHCS Commercial |
$66.35
|
| Rate for Payer: United Healthcare All Payer |
$60.82
|
|
|
CALCIUM GLUC 10MG (1GM PREMIX)
|
Facility
|
OP
|
$69.11
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
25004230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$66.35 |
| Rate for Payer: Aetna Commercial |
$53.21
|
| Rate for Payer: Anthem Medicaid |
$23.77
|
| 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: Humana KY Medicaid |
$23.77
|
| 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 |
$20.73
|
| 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 |
$55.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.69
|
| Rate for Payer: PHCS Commercial |
$66.35
|
| Rate for Payer: United Healthcare All Payer |
$60.82
|
|
|
CALCIUM GLUC 10MG (1GM SDV)
|
Facility
|
IP
|
$54.61
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
25001913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.38 |
| 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 |
$43.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.68
|
| Rate for Payer: PHCS Commercial |
$52.43
|
| Rate for Payer: United Healthcare All Payer |
$48.06
|
|
|
CALCIUM GLUC 10MG (1GM SDV)
|
Facility
|
OP
|
$54.61
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
25001913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$42.05
|
| Rate for Payer: Anthem Medicaid |
$18.78
|
| 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: Humana KY Medicaid |
$18.78
|
| 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 |
$16.38
|
| 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 |
$43.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.68
|
| Rate for Payer: PHCS Commercial |
$52.43
|
| Rate for Payer: United Healthcare All Payer |
$48.06
|
|
|
CALCIUM GLUC 10MG(4.6mEqPREMX)
|
Facility
|
IP
|
$69.11
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
25004388
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.73 |
| 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 |
$55.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.69
|
| Rate for Payer: PHCS Commercial |
$66.35
|
| Rate for Payer: United Healthcare All Payer |
$60.82
|
|
|
CALCIUM GLUC 10MG(4.6mEqPREMX)
|
Facility
|
OP
|
$69.11
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
25004388
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$66.35 |
| Rate for Payer: Aetna Commercial |
$53.21
|
| Rate for Payer: Anthem Medicaid |
$23.77
|
| 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: Humana KY Medicaid |
$23.77
|
| 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 |
$20.73
|
| 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 |
$55.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.69
|
| Rate for Payer: PHCS Commercial |
$66.35
|
| Rate for Payer: United Healthcare All Payer |
$60.82
|
|
|
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 |
$16.38 |
| 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 |
$43.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.68
|
| Rate for Payer: PHCS Commercial |
$52.43
|
| Rate for Payer: United Healthcare All Payer |
$48.06
|
|
