|
GLOBAL SHLDR GLENOD PEG SZ44
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
GLOSSECTOMY
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 41120
|
| Hospital Charge Code |
76101660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
GLOSSECTOMY
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 41120
|
| Hospital Charge Code |
76101660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
GLOSSECTOMY
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 41120
|
| Hospital Charge Code |
76101660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.75 |
| Max. Negotiated Rate |
$1,478.21 |
| Rate for Payer: Aetna Commercial |
$1,470.72
|
| Rate for Payer: Anthem Medicaid |
$475.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,478.21
|
| Rate for Payer: Healthspan PPO |
$1,240.29
|
| Rate for Payer: Humana Medicaid |
$475.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,337.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.26
|
| Rate for Payer: Molina Healthcare Passport |
$475.75
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.51
|
|
|
GLOSSECTOMY(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 41120
|
| Hospital Charge Code |
761P1660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.75 |
| Max. Negotiated Rate |
$1,478.21 |
| Rate for Payer: Aetna Commercial |
$1,470.72
|
| Rate for Payer: Anthem Medicaid |
$475.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,478.21
|
| Rate for Payer: Healthspan PPO |
$1,240.29
|
| Rate for Payer: Humana Medicaid |
$475.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,337.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.26
|
| Rate for Payer: Molina Healthcare Passport |
$475.75
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.51
|
|
|
GLOW FOWARD
|
Professional
|
Both
|
$85.00
|
|
| Hospital Charge Code |
22200138
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$85.00
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
|
|
GLUCAGON 1 MG/1 ML INJ 1MG/1ML
|
Facility
|
IP
|
$560.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
636T0034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.88 |
| Max. Negotiated Rate |
$538.18 |
| Rate for Payer: Aetna Commercial |
$431.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.27
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cigna Commercial |
$465.30
|
| Rate for Payer: First Health Commercial |
$532.57
|
| Rate for Payer: Humana Commercial |
$476.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.33
|
| Rate for Payer: Ohio Health Group HMO |
$420.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.79
|
| Rate for Payer: PHCS Commercial |
$538.18
|
| Rate for Payer: United Healthcare All Payer |
$493.33
|
|
|
GLUCAGON 1 MG/1 ML INJ 1MG/1ML
|
Facility
|
IP
|
$560.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.88 |
| Max. Negotiated Rate |
$538.18 |
| Rate for Payer: Aetna Commercial |
$431.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.27
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cigna Commercial |
$465.30
|
| Rate for Payer: First Health Commercial |
$532.57
|
| Rate for Payer: Humana Commercial |
$476.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.33
|
| Rate for Payer: Ohio Health Group HMO |
$420.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.79
|
| Rate for Payer: PHCS Commercial |
$538.18
|
| Rate for Payer: United Healthcare All Payer |
$493.33
|
|
|
GLUCAGON 1 MG/1 ML INJ 1MG/1ML
|
Facility
|
OP
|
$599.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
25002119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$575.62 |
| Rate for Payer: Aetna Commercial |
$461.69
|
| Rate for Payer: Anthem Medicaid |
$206.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$188.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$254.30
|
| Rate for Payer: Cash Price |
$299.80
|
| Rate for Payer: Cash Price |
$299.80
|
| Rate for Payer: Cigna Commercial |
$497.67
|
| Rate for Payer: First Health Commercial |
$569.62
|
| Rate for Payer: Humana Commercial |
$509.66
|
| Rate for Payer: Humana KY Medicaid |
$206.20
|
| Rate for Payer: Humana Medicare Advantage |
$188.37
|
| Rate for Payer: Kentucky WC Medicaid |
$208.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.65
|
| Rate for Payer: Ohio Health Group HMO |
$449.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.88
|
| Rate for Payer: PHCS Commercial |
$575.62
|
| Rate for Payer: United Healthcare All Payer |
$527.65
|
|
|
GLUCAGON 1 MG/1 ML INJ 1MG/1ML
|
Facility
|
OP
|
$560.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
636T0034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.88 |
| Max. Negotiated Rate |
$538.18 |
| Rate for Payer: Aetna Commercial |
$431.66
|
| Rate for Payer: Anthem Medicaid |
$192.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$188.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$254.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cigna Commercial |
$465.30
|
| Rate for Payer: First Health Commercial |
$532.57
|
| Rate for Payer: Humana Commercial |
$476.51
|
| Rate for Payer: Humana KY Medicaid |
$192.79
|
| Rate for Payer: Humana Medicare Advantage |
$188.37
|
| Rate for Payer: Kentucky WC Medicaid |
$194.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.33
|
| Rate for Payer: Ohio Health Group HMO |
$420.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.79
|
| Rate for Payer: PHCS Commercial |
$538.18
|
| Rate for Payer: United Healthcare All Payer |
$493.33
|
|
|
GLUCAGON 1 MG/1 ML INJ 1MG/1ML
|
Facility
|
IP
|
$599.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
25002119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$575.62 |
| Rate for Payer: Aetna Commercial |
$461.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.69
|
| Rate for Payer: Cash Price |
$299.80
|
| Rate for Payer: Cigna Commercial |
$497.67
|
| Rate for Payer: First Health Commercial |
$569.62
|
| Rate for Payer: Humana Commercial |
$509.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.65
|
| Rate for Payer: Ohio Health Group HMO |
$449.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.88
|
| Rate for Payer: PHCS Commercial |
$575.62
|
| Rate for Payer: United Healthcare All Payer |
$527.65
|
|
|
GLUCAGON 1 MG/1 ML INJ 1MG/1ML
|
Facility
|
OP
|
$560.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.88 |
| Max. Negotiated Rate |
$538.18 |
| Rate for Payer: Aetna Commercial |
$431.66
|
| Rate for Payer: Anthem Medicaid |
$192.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$188.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$437.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$254.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cigna Commercial |
$465.30
|
| Rate for Payer: First Health Commercial |
$532.57
|
| Rate for Payer: Humana Commercial |
$476.51
|
| Rate for Payer: Humana KY Medicaid |
$192.79
|
| Rate for Payer: Humana Medicare Advantage |
$188.37
|
| Rate for Payer: Kentucky WC Medicaid |
$194.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$493.33
|
| Rate for Payer: Ohio Health Group HMO |
$420.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.79
|
| Rate for Payer: PHCS Commercial |
$538.18
|
| Rate for Payer: United Healthcare All Payer |
$493.33
|
|
|
GLUCAGON 1 MG/1 ML INJ 1MG/1ML
|
Professional
|
Both
|
$560.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.21 |
| Max. Negotiated Rate |
$560.60 |
| Rate for Payer: Aetna Commercial |
$234.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.60
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$289.01
|
| Rate for Payer: Multiplan PHCS |
$336.36
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.42
|
| Rate for Payer: UHCCP Medicaid |
$196.21
|
|
|
GLUCAGON KIT 1 MG/ML KIT
|
Facility
|
OP
|
$887.70
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
25003951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.40 |
| Max. Negotiated Rate |
$852.19 |
| Rate for Payer: Anthem Medicaid |
$305.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$188.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$254.30
|
| Rate for Payer: Cash Price |
$443.85
|
| Rate for Payer: Cash Price |
$443.85
|
| Rate for Payer: Cigna Commercial |
$736.79
|
| Rate for Payer: First Health Commercial |
$843.32
|
| Rate for Payer: Humana Commercial |
$754.54
|
| Rate for Payer: Humana KY Medicaid |
$305.28
|
| Rate for Payer: Humana Medicare Advantage |
$188.37
|
| Rate for Payer: Kentucky WC Medicaid |
$308.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.18
|
| Rate for Payer: Ohio Health Group HMO |
$665.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$275.19
|
| Rate for Payer: PHCS Commercial |
$852.19
|
| Rate for Payer: United Healthcare All Payer |
$781.18
|
| Rate for Payer: Aetna Commercial |
$683.53
|
|
|
GLUCAGON KIT 1 MG/ML KIT
|
Facility
|
IP
|
$887.70
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
25003951
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.40 |
| Max. Negotiated Rate |
$852.19 |
| Rate for Payer: Aetna Commercial |
$683.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.41
|
| Rate for Payer: Cash Price |
$443.85
|
| Rate for Payer: Cigna Commercial |
$736.79
|
| Rate for Payer: First Health Commercial |
$843.32
|
| Rate for Payer: Humana Commercial |
$754.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.18
|
| Rate for Payer: Ohio Health Group HMO |
$665.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$275.19
|
| Rate for Payer: PHCS Commercial |
$852.19
|
| Rate for Payer: United Healthcare All Payer |
$781.18
|
|
|
GLUCERNA 1.5Cal 1,000mL Bottle
|
Facility
|
IP
|
$79.52
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
25004382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Aetna Commercial |
$61.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.03
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cigna Commercial |
$66.00
|
| Rate for Payer: First Health Commercial |
$75.54
|
| Rate for Payer: Humana Commercial |
$67.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.98
|
| Rate for Payer: Ohio Health Group HMO |
$59.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.65
|
| Rate for Payer: PHCS Commercial |
$76.34
|
| Rate for Payer: United Healthcare All Payer |
$69.98
|
|
|
GLUCERNA 1.5Cal 1,000mL Bottle
|
Facility
|
OP
|
$79.52
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
25004382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Aetna Commercial |
$61.23
|
| Rate for Payer: Anthem Medicaid |
$27.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.03
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cigna Commercial |
$66.00
|
| Rate for Payer: First Health Commercial |
$75.54
|
| Rate for Payer: Humana Commercial |
$67.59
|
| Rate for Payer: Humana KY Medicaid |
$27.35
|
| Rate for Payer: Kentucky WC Medicaid |
$27.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.98
|
| Rate for Payer: Ohio Health Group HMO |
$59.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.65
|
| Rate for Payer: PHCS Commercial |
$76.34
|
| Rate for Payer: United Healthcare All Payer |
$69.98
|
|
|
GLUCERNA SELECT RTH 1000 ML
|
Facility
|
IP
|
$73.71
|
|
|
Service Code
|
NDC 70074062672
|
| Hospital Charge Code |
25003084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$70.76 |
| Rate for Payer: Aetna Commercial |
$56.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.49
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Cigna Commercial |
$61.18
|
| Rate for Payer: First Health Commercial |
$70.02
|
| Rate for Payer: Humana Commercial |
$62.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.86
|
| Rate for Payer: Ohio Health Group HMO |
$55.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.85
|
| Rate for Payer: PHCS Commercial |
$70.76
|
| Rate for Payer: United Healthcare All Payer |
$64.86
|
|
|
GLUCERNA SELECT RTH 1000 ML
|
Facility
|
OP
|
$73.71
|
|
|
Service Code
|
NDC 70074062672
|
| Hospital Charge Code |
25003084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$70.76 |
| Rate for Payer: Aetna Commercial |
$56.76
|
| Rate for Payer: Anthem Medicaid |
$25.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.49
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Cigna Commercial |
$61.18
|
| Rate for Payer: First Health Commercial |
$70.02
|
| Rate for Payer: Humana Commercial |
$62.65
|
| Rate for Payer: Humana KY Medicaid |
$25.35
|
| Rate for Payer: Kentucky WC Medicaid |
$25.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.86
|
| Rate for Payer: Ohio Health Group HMO |
$55.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.85
|
| Rate for Payer: PHCS Commercial |
$70.76
|
| Rate for Payer: United Healthcare All Payer |
$64.86
|
|
|
GLUCOPHAGE (METFORM 500MG/1TAB
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 60687015501
|
| Hospital Charge Code |
25000724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
GLUCOPHAGE (METFORM 500MG/1TAB
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 60687015501
|
| Hospital Charge Code |
25000724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.16 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.38
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.11
|
| Rate for Payer: Humana Commercial |
$3.68
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.81
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
|
GLUCOPHAGE (METFORM 850MG/1TAB
|
Facility
|
IP
|
$4.42
|
|
|
Service Code
|
NDC 60687014301
|
| Hospital Charge Code |
25000725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.67
|
| Rate for Payer: First Health Commercial |
$4.20
|
| Rate for Payer: Humana Commercial |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.89
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
GLUCOPHAGE (METFORM 850MG/1TAB
|
Facility
|
OP
|
$4.42
|
|
|
Service Code
|
NDC 60687014301
|
| Hospital Charge Code |
25000725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.67
|
| Rate for Payer: First Health Commercial |
$4.20
|
| Rate for Payer: Humana Commercial |
$3.76
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.89
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
GLUCOSE
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
30000340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Anthem Medicaid |
$3.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.93
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: First Health Commercial |
$44.65
|
| Rate for Payer: Humana Commercial |
$39.95
|
| Rate for Payer: Humana KY Medicaid |
$3.93
|
| Rate for Payer: Humana Medicare Advantage |
$3.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.36
|
| Rate for Payer: Ohio Health Group HMO |
$35.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.57
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
GLUCOSE
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
30000340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.74
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: First Health Commercial |
$44.65
|
| Rate for Payer: Humana Commercial |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.36
|
| Rate for Payer: Ohio Health Group HMO |
$35.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.57
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
