|
GLUCOPHAGE (METFORM 500MG/1TAB
|
Facility
|
OP
|
$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 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 |
$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
|
|
|
GLUCOPHAGE (METFORM 850MG/1TAB
|
Facility
|
OP
|
$4.42
|
|
|
Service Code
|
NDC 60687014301
|
| Hospital Charge Code |
25000725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| 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 |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
GLUCOPHAGE (METFORM 850MG/1TAB
|
Facility
|
IP
|
$4.42
|
|
|
Service Code
|
NDC 60687014301
|
| Hospital Charge Code |
25000725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| 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 |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
GLUCOSE
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
30000340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem Medicaid |
$3.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.93
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| 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 |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.81
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
GLUCOSE
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
30000340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$29.40 |
| Rate for Payer: Aetna Commercial |
$8.77
|
| Rate for Payer: Ambetter Exchange |
$3.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.72
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$5.37
|
| Rate for Payer: Healthspan PPO |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.93
|
| Rate for Payer: Multiplan PHCS |
$29.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.11
|
| Rate for Payer: UHCCP Medicaid |
$17.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.93
|
|
|
GLUCOSE
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
30000340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.35
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.81
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
GLUCOSE 4GM TAB CHEW
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 87701042600
|
| Hospital Charge Code |
25003737
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
GLUCOSE 4GM TAB CHEW
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 87701042600
|
| Hospital Charge Code |
25003737
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.97
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
GLUCOSE FINGER STICK
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
30000348
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem Medicaid |
$3.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.28
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Humana KY Medicaid |
$3.28
|
| Rate for Payer: Humana Medicare Advantage |
$3.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.18
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
GLUCOSE FINGER STICK
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
30000348
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: Aetna Commercial |
$4.23
|
| Rate for Payer: Ambetter Exchange |
$3.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$3.45
|
| Rate for Payer: Healthspan PPO |
$2.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.28
|
| Rate for Payer: Multiplan PHCS |
$13.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4.26
|
| Rate for Payer: UHCCP Medicaid |
$7.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.28
|
|
|
GLUCOSE FINGER STICK
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
30000348
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.18
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
GLUCOSE; FLUID
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
30000339
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.35
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.81
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
GLUCOSE; FLUID
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
30000339
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Aetna Commercial |
$37.73
|
| Rate for Payer: Anthem Medicaid |
$3.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.93
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: Cigna Commercial |
$40.67
|
| Rate for Payer: First Health Commercial |
$46.55
|
| Rate for Payer: Humana Commercial |
$41.65
|
| 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 |
$40.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$43.12
|
| Rate for Payer: Ohio Health Group HMO |
$36.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.81
|
| Rate for Payer: PHCS Commercial |
$47.04
|
| Rate for Payer: United Healthcare All Payer |
$43.12
|
|
|
GLUCOSE POST GLUCOSE DOSE
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
30000342
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.97
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.64
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
GLUCOSE POST GLUCOSE DOSE
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
30000342
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem Medicaid |
$4.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Humana KY Medicaid |
$4.75
|
| Rate for Payer: Humana Medicare Advantage |
$4.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.64
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
GLUCOSE TOLERANCE 1-3 HR
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
30000343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$12.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.87
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$12.87
|
| Rate for Payer: Humana Medicare Advantage |
$12.87
|
| Rate for Payer: Kentucky WC Medicaid |
$13.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
GLUCOSE TOLERANCE 1-3 HR
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
30000343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
GLUCOSE TOLERANCE EA ADDTL
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 82952
|
| Hospital Charge Code |
30000344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.13
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
GLUCOSE TOLERANCE EA ADDTL
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 82952
|
| Hospital Charge Code |
30000346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.74
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
GLUCOSE TOLERANCE EA ADDTL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 82952
|
| Hospital Charge Code |
30000346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$3.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.92
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$3.92
|
| Rate for Payer: Humana Medicare Advantage |
$3.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.74
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
GLUCOSE TOLERANCE EA ADDTL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 82952
|
| Hospital Charge Code |
30000344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$3.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.92
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$3.92
|
| Rate for Payer: Humana Medicare Advantage |
$3.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
GLUCOSE TOLERANCE EA ADDTL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 82952
|
| Hospital Charge Code |
30000345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$3.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.92
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$3.92
|
| Rate for Payer: Humana Medicare Advantage |
$3.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.74
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
GLUCOSE TOLERANCE EA ADDTL
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 82952
|
| Hospital Charge Code |
30000345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.74
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
GLUCOTROL (GLIPIZIDE) 5MG/1TAB
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 60687069001
|
| Hospital Charge Code |
25000727
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
GLUCOTROL (GLIPIZIDE) 5MG/1TAB
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 60687069001
|
| Hospital Charge Code |
25000727
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.12
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
