|
GLUCOTROL XL (GLIPIZI 5MG/1TAB
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 64980028001
|
| Hospital Charge Code |
25000728
|
|
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
|
|
|
GLUCOTROL XL (GLIPIZI 5MG/1TAB
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 64980028001
|
| Hospital Charge Code |
25000728
|
|
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
|
|
|
GLYCERIN ADULT SUPP. 1EA
|
Facility
|
IP
|
$4.28
|
|
|
Service Code
|
NDC 132007924
|
| Hospital Charge Code |
25000731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
GLYCERIN ADULT SUPP. 1EA
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 132007924
|
| Hospital Charge Code |
25000731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
|
GLYCERIN PEDIATRIC SUPP. 1EA
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 46122022263
|
| Hospital Charge Code |
25000732
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
GLYCERIN PEDIATRIC SUPP. 1EA
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 46122022263
|
| Hospital Charge Code |
25000732
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
GLYCINE IRRIGATION 3000ML
|
Facility
|
OP
|
$90.99
|
|
|
Service Code
|
NDC 990797408
|
| Hospital Charge Code |
25003085
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$87.35 |
| Rate for Payer: Aetna Commercial |
$70.06
|
| Rate for Payer: Anthem Medicaid |
$31.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.97
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Cigna Commercial |
$75.52
|
| Rate for Payer: First Health Commercial |
$86.44
|
| Rate for Payer: Humana Commercial |
$77.34
|
| Rate for Payer: Humana KY Medicaid |
$31.29
|
| Rate for Payer: Kentucky WC Medicaid |
$31.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.07
|
| Rate for Payer: Ohio Health Group HMO |
$68.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.78
|
| Rate for Payer: PHCS Commercial |
$87.35
|
| Rate for Payer: United Healthcare All Payer |
$80.07
|
|
|
GLYCINE IRRIGATION 3000ML
|
Facility
|
IP
|
$90.99
|
|
|
Service Code
|
NDC 990797408
|
| Hospital Charge Code |
25003085
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$87.35 |
| Rate for Payer: Aetna Commercial |
$70.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.97
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Cigna Commercial |
$75.52
|
| Rate for Payer: First Health Commercial |
$86.44
|
| Rate for Payer: Humana Commercial |
$77.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.07
|
| Rate for Payer: Ohio Health Group HMO |
$68.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.78
|
| Rate for Payer: PHCS Commercial |
$87.35
|
| Rate for Payer: United Healthcare All Payer |
$80.07
|
|
|
GMRS AXLE SMALL
|
Facility
|
OP
|
$6,965.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,089.61 |
| Max. Negotiated Rate |
$6,686.75 |
| Rate for Payer: Aetna Commercial |
$5,363.33
|
| Rate for Payer: Anthem Medicaid |
$2,395.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,432.98
|
| Rate for Payer: Cash Price |
$3,482.68
|
| Rate for Payer: Cigna Commercial |
$5,781.25
|
| Rate for Payer: First Health Commercial |
$6,617.09
|
| Rate for Payer: Humana Commercial |
$5,920.56
|
| Rate for Payer: Humana KY Medicaid |
$2,395.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,419.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,711.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,140.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,089.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,443.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,129.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,224.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,572.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,059.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,806.10
|
| Rate for Payer: PHCS Commercial |
$6,686.75
|
| Rate for Payer: United Healthcare All Payer |
$6,129.52
|
|
|
GMRS AXLE SMALL
|
Facility
|
IP
|
$6,965.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,089.61 |
| Max. Negotiated Rate |
$6,686.75 |
| Rate for Payer: Aetna Commercial |
$5,363.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,432.98
|
| Rate for Payer: Cash Price |
$3,482.68
|
| Rate for Payer: Cigna Commercial |
$5,781.25
|
| Rate for Payer: First Health Commercial |
$6,617.09
|
| Rate for Payer: Humana Commercial |
$5,920.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,711.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,140.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,089.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,129.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,224.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,572.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,059.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,806.10
|
| Rate for Payer: PHCS Commercial |
$6,686.75
|
| Rate for Payer: United Healthcare All Payer |
$6,129.52
|
|
|
GMRS CEM CVD STEM 10MM
|
Facility
|
OP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem Medicaid |
$5,825.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Humana KY Medicaid |
$5,825.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,884.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,942.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM CVD STEM 10MM
|
Facility
|
IP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM CVD STEM 11MM
|
Facility
|
OP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem Medicaid |
$5,825.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Humana KY Medicaid |
$5,825.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,884.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,942.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM CVD STEM 11MM
|
Facility
|
IP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM CVD STEM 13MM
|
Facility
|
OP
|
$20,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,089.10 |
| Max. Negotiated Rate |
$19,485.12 |
| Rate for Payer: Aetna Commercial |
$15,628.69
|
| Rate for Payer: Anthem Medicaid |
$6,980.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,831.66
|
| Rate for Payer: Cash Price |
$10,148.50
|
| Rate for Payer: Cigna Commercial |
$16,846.51
|
| Rate for Payer: First Health Commercial |
$19,282.15
|
| Rate for Payer: Humana Commercial |
$17,252.45
|
| Rate for Payer: Humana KY Medicaid |
$6,980.14
|
| Rate for Payer: Kentucky WC Medicaid |
$7,051.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,643.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,979.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,089.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,120.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,861.36
|
| Rate for Payer: Ohio Health Group HMO |
$15,222.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,658.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,004.93
|
| Rate for Payer: PHCS Commercial |
$19,485.12
|
| Rate for Payer: United Healthcare All Payer |
$17,861.36
|
|
|
GMRS CEM CVD STEM 13MM
|
Facility
|
IP
|
$20,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,089.10 |
| Max. Negotiated Rate |
$19,485.12 |
| Rate for Payer: Aetna Commercial |
$15,628.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,831.66
|
| Rate for Payer: Cash Price |
$10,148.50
|
| Rate for Payer: Cigna Commercial |
$16,846.51
|
| Rate for Payer: First Health Commercial |
$19,282.15
|
| Rate for Payer: Humana Commercial |
$17,252.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,643.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,979.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,089.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,861.36
|
| Rate for Payer: Ohio Health Group HMO |
$15,222.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,658.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,004.93
|
| Rate for Payer: PHCS Commercial |
$19,485.12
|
| Rate for Payer: United Healthcare All Payer |
$17,861.36
|
|
|
GMRS CEM CVD STEM 15MM
|
Facility
|
OP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem Medicaid |
$5,825.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Humana KY Medicaid |
$5,825.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,884.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,942.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM CVD STEM 15MM
|
Facility
|
IP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM CVD STEM 17MM
|
Facility
|
IP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM CVD STEM 17MM
|
Facility
|
OP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem Medicaid |
$5,825.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Humana KY Medicaid |
$5,825.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,884.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,942.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM CVD STEM 8MM
|
Facility
|
IP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM CVD STEM 8MM
|
Facility
|
OP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem Medicaid |
$5,825.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Humana KY Medicaid |
$5,825.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,884.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,942.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM CVD STEM 9MM
|
Facility
|
IP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM CVD STEM 9MM
|
Facility
|
OP
|
$16,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,081.57 |
| Max. Negotiated Rate |
$16,261.02 |
| Rate for Payer: Aetna Commercial |
$13,042.69
|
| Rate for Payer: Anthem Medicaid |
$5,825.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,212.08
|
| Rate for Payer: Cash Price |
$8,469.28
|
| Rate for Payer: Cigna Commercial |
$14,059.00
|
| Rate for Payer: First Health Commercial |
$16,091.63
|
| Rate for Payer: Humana Commercial |
$14,397.78
|
| Rate for Payer: Humana KY Medicaid |
$5,825.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,884.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,889.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,500.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,081.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,942.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,905.93
|
| Rate for Payer: Ohio Health Group HMO |
$12,703.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,550.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,736.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,687.61
|
| Rate for Payer: PHCS Commercial |
$16,261.02
|
| Rate for Payer: United Healthcare All Payer |
$14,905.93
|
|
|
GMRS CEM CVD STEM WO BODY 10MM
|
Facility
|
IP
|
$12,510.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,753.17 |
| Max. Negotiated Rate |
$12,010.16 |
| Rate for Payer: Aetna Commercial |
$9,633.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,758.25
|
| Rate for Payer: Cash Price |
$6,255.29
|
| Rate for Payer: Cigna Commercial |
$10,383.78
|
| Rate for Payer: First Health Commercial |
$11,885.05
|
| Rate for Payer: Humana Commercial |
$10,633.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,232.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,753.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,009.31
|
| Rate for Payer: Ohio Health Group HMO |
$9,382.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,008.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,884.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,632.30
|
| Rate for Payer: PHCS Commercial |
$12,010.16
|
| Rate for Payer: United Healthcare All Payer |
$11,009.31
|
|
