|
GLUCAGON 1 MG/1 ML INJ 1MG/1ML
|
Facility
|
OP
|
$599.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.79 |
| 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 |
$195.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$274.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$264.32
|
| 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 |
$195.79
|
| 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 |
$234.95
|
| 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 |
$479.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.72
|
| 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
|
IP
|
$599.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
636T0034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.88 |
| 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 |
$479.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.72
|
| 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
|
IP
|
$599.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.88 |
| 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 |
$479.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.72
|
| Rate for Payer: PHCS Commercial |
$575.62
|
| Rate for Payer: United Healthcare All Payer |
$527.65
|
|
|
GLUCAGON 1 MG/1 ML INJ 1MG/1ML
|
Professional
|
Both
|
$599.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.79 |
| Max. Negotiated Rate |
$359.76 |
| Rate for Payer: Aetna Commercial |
$234.92
|
| Rate for Payer: Ambetter Exchange |
$195.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$195.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$195.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$234.95
|
| Rate for Payer: Cash Price |
$299.80
|
| Rate for Payer: Cash Price |
$299.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$289.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$195.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.79
|
| Rate for Payer: Multiplan PHCS |
$359.76
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$254.53
|
| Rate for Payer: UHCCP Medicaid |
$209.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$195.79
|
|
|
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 |
$195.79 |
| 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 |
$195.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$274.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$264.32
|
| 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 |
$195.79
|
| 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 |
$234.95
|
| 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 |
$479.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.72
|
| 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
|
$599.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
636T0034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.79 |
| 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 |
$195.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$274.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$264.32
|
| 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 |
$195.79
|
| 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 |
$234.95
|
| 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 |
$479.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.72
|
| 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
|
IP
|
$599.60
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
25002119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.88 |
| 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 |
$479.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.72
|
| Rate for Payer: PHCS Commercial |
$575.62
|
| Rate for Payer: United Healthcare All Payer |
$527.65
|
|
|
GLUCAGON1MG(FRES)SDV
|
Facility
|
OP
|
$599.60
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
636T0233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.88 |
| 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 |
$144.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.59
|
| 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 |
$144.88
|
| 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 |
$173.86
|
| 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 |
$479.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.72
|
| Rate for Payer: PHCS Commercial |
$575.62
|
| Rate for Payer: United Healthcare All Payer |
$527.65
|
|
|
GLUCAGON1MG(FRES)SDV
|
Professional
|
Both
|
$599.60
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$359.76 |
| Rate for Payer: Ambetter Exchange |
$144.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$144.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$173.86
|
| Rate for Payer: Cash Price |
$299.80
|
| Rate for Payer: Cash Price |
$299.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$144.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.88
|
| Rate for Payer: Multiplan PHCS |
$359.76
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$188.34
|
| Rate for Payer: UHCCP Medicaid |
$209.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.88
|
|
|
GLUCAGON1MG(FRES)SDV
|
Facility
|
OP
|
$599.60
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.88 |
| 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 |
$144.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.59
|
| 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 |
$144.88
|
| 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 |
$173.86
|
| 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 |
$479.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.72
|
| Rate for Payer: PHCS Commercial |
$575.62
|
| Rate for Payer: United Healthcare All Payer |
$527.65
|
|
|
GLUCAGON1MG(FRES)SDV
|
Facility
|
IP
|
$599.60
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
636T0233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.88 |
| 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 |
$479.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.72
|
| Rate for Payer: PHCS Commercial |
$575.62
|
| Rate for Payer: United Healthcare All Payer |
$527.65
|
|
|
GLUCAGON1MG(FRES)SDV
|
Facility
|
IP
|
$599.60
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.88 |
| 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 |
$479.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.72
|
| Rate for Payer: PHCS Commercial |
$575.62
|
| Rate for Payer: United Healthcare All Payer |
$527.65
|
|
|
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 |
$266.31 |
| 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 |
$665.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.51
|
| Rate for Payer: PHCS Commercial |
$852.19
|
| Rate for Payer: United Healthcare All Payer |
$781.18
|
|
|
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 |
$195.79 |
| Max. Negotiated Rate |
$852.19 |
| Rate for Payer: Aetna Commercial |
$683.53
|
| Rate for Payer: Anthem Medicaid |
$305.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$195.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$274.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$264.32
|
| 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 |
$195.79
|
| 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 |
$234.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.18
|
| Rate for Payer: Ohio Health Group HMO |
$665.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.51
|
| Rate for Payer: PHCS Commercial |
$852.19
|
| Rate for Payer: United Healthcare All Payer |
$781.18
|
|
|
GLUCERNA 1.0 237ML
|
Facility
|
OP
|
$66.86
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
25004548
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$64.19 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Anthem Medicaid |
$22.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.15
|
| Rate for Payer: Cash Price |
$33.43
|
| Rate for Payer: Cigna Commercial |
$55.49
|
| Rate for Payer: First Health Commercial |
$63.52
|
| Rate for Payer: Humana Commercial |
$56.83
|
| Rate for Payer: Humana KY Medicaid |
$22.99
|
| Rate for Payer: Kentucky WC Medicaid |
$23.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.84
|
| Rate for Payer: Ohio Health Group HMO |
$50.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.13
|
| Rate for Payer: PHCS Commercial |
$64.19
|
| Rate for Payer: United Healthcare All Payer |
$58.84
|
|
|
GLUCERNA 1.0 237ML
|
Facility
|
IP
|
$66.86
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
25004548
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$64.19 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.15
|
| Rate for Payer: Cash Price |
$33.43
|
| Rate for Payer: Cigna Commercial |
$55.49
|
| Rate for Payer: First Health Commercial |
$63.52
|
| Rate for Payer: Humana Commercial |
$56.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.84
|
| Rate for Payer: Ohio Health Group HMO |
$50.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.13
|
| Rate for Payer: PHCS Commercial |
$64.19
|
| Rate for Payer: United Healthcare All Payer |
$58.84
|
|
|
GLUCERNA 1.2 237ML
|
Facility
|
IP
|
$66.68
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
25004552
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$64.01 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.01
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Cigna Commercial |
$55.34
|
| Rate for Payer: First Health Commercial |
$63.35
|
| Rate for Payer: Humana Commercial |
$56.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.68
|
| Rate for Payer: Ohio Health Group HMO |
$50.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.01
|
| Rate for Payer: PHCS Commercial |
$64.01
|
| Rate for Payer: United Healthcare All Payer |
$58.68
|
|
|
GLUCERNA 1.2 237ML
|
Facility
|
OP
|
$66.68
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
25004552
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$64.01 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Anthem Medicaid |
$22.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.01
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Cigna Commercial |
$55.34
|
| Rate for Payer: First Health Commercial |
$63.35
|
| Rate for Payer: Humana Commercial |
$56.68
|
| Rate for Payer: Humana KY Medicaid |
$22.93
|
| Rate for Payer: Kentucky WC Medicaid |
$23.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.68
|
| Rate for Payer: Ohio Health Group HMO |
$50.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.01
|
| Rate for Payer: PHCS Commercial |
$64.01
|
| Rate for Payer: United Healthcare All Payer |
$58.68
|
|
|
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 |
$23.86 |
| 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 |
$63.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.87
|
| Rate for Payer: PHCS Commercial |
$76.34
|
| Rate for Payer: United Healthcare All Payer |
$69.98
|
|
|
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 |
$23.86 |
| 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 |
$63.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.87
|
| Rate for Payer: PHCS Commercial |
$76.34
|
| Rate for Payer: United Healthcare All Payer |
$69.98
|
|
|
GLUCERNA237
|
Facility
|
OP
|
$65.86
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
25004536
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: Aetna Commercial |
$50.71
|
| Rate for Payer: Anthem Medicaid |
$22.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.37
|
| Rate for Payer: Cash Price |
$32.93
|
| Rate for Payer: Cigna Commercial |
$54.66
|
| Rate for Payer: First Health Commercial |
$62.57
|
| Rate for Payer: Humana Commercial |
$55.98
|
| Rate for Payer: Humana KY Medicaid |
$22.65
|
| Rate for Payer: Kentucky WC Medicaid |
$22.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.96
|
| Rate for Payer: Ohio Health Group HMO |
$49.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.44
|
| Rate for Payer: PHCS Commercial |
$63.23
|
| Rate for Payer: United Healthcare All Payer |
$57.96
|
|
|
GLUCERNA237
|
Facility
|
IP
|
$65.86
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
25004536
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: Aetna Commercial |
$50.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.37
|
| Rate for Payer: Cash Price |
$32.93
|
| Rate for Payer: Cigna Commercial |
$54.66
|
| Rate for Payer: First Health Commercial |
$62.57
|
| Rate for Payer: Humana Commercial |
$55.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.96
|
| Rate for Payer: Ohio Health Group HMO |
$49.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.44
|
| Rate for Payer: PHCS Commercial |
$63.23
|
| Rate for Payer: United Healthcare All Payer |
$57.96
|
|
|
GLUCERNA SELECT RTH 1000 ML
|
Facility
|
OP
|
$73.71
|
|
|
Service Code
|
NDC 70074062672
|
| Hospital Charge Code |
25003084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.11 |
| 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 |
$58.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.86
|
| Rate for Payer: PHCS Commercial |
$70.76
|
| Rate for Payer: United Healthcare All Payer |
$64.86
|
|
|
GLUCERNA SELECT RTH 1000 ML
|
Facility
|
IP
|
$73.71
|
|
|
Service Code
|
NDC 70074062672
|
| Hospital Charge Code |
25003084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.11 |
| 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 |
$58.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.86
|
| 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 |
$1.30 |
| 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 |
$3.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.16
|
| Rate for Payer: United Healthcare All Payer |
$3.81
|
|
