|
HUMULIN 5 UNITS [70/30 PEN]
|
Facility
|
IP
|
$72.92
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002173
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$56.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.88
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cigna Commercial |
$60.52
|
| Rate for Payer: First Health Commercial |
$69.27
|
| Rate for Payer: Humana Commercial |
$61.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.17
|
| Rate for Payer: Ohio Health Group HMO |
$54.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.61
|
| Rate for Payer: PHCS Commercial |
$70.00
|
| Rate for Payer: United Healthcare All Payer |
$64.17
|
|
|
HUMULIN 70/30 5U (10ML VIAL)
|
Facility
|
OP
|
$243.12
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$233.40 |
| Rate for Payer: Anthem Medicaid |
$83.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.63
|
| Rate for Payer: Cash Price |
$121.56
|
| Rate for Payer: Cigna Commercial |
$201.79
|
| Rate for Payer: First Health Commercial |
$230.96
|
| Rate for Payer: Humana Commercial |
$206.65
|
| Rate for Payer: Humana KY Medicaid |
$83.61
|
| Rate for Payer: Kentucky WC Medicaid |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.95
|
| Rate for Payer: Ohio Health Group HMO |
$182.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.37
|
| Rate for Payer: PHCS Commercial |
$233.40
|
| Rate for Payer: United Healthcare All Payer |
$213.95
|
| Rate for Payer: Aetna Commercial |
$187.20
|
|
|
HUMULIN 70/30 5U (10ML VIAL)
|
Facility
|
IP
|
$243.12
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$233.40 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.63
|
| Rate for Payer: Cash Price |
$121.56
|
| Rate for Payer: Cigna Commercial |
$201.79
|
| Rate for Payer: First Health Commercial |
$230.96
|
| Rate for Payer: Humana Commercial |
$206.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.95
|
| Rate for Payer: Ohio Health Group HMO |
$182.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.37
|
| Rate for Payer: PHCS Commercial |
$233.40
|
| Rate for Payer: United Healthcare All Payer |
$213.95
|
|
|
HUMULIN 70/30 KWIKPEN
|
Facility
|
IP
|
$63.31
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25003751
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$60.78 |
| Rate for Payer: Aetna Commercial |
$48.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.38
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cigna Commercial |
$52.55
|
| Rate for Payer: First Health Commercial |
$60.14
|
| Rate for Payer: Humana Commercial |
$53.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.71
|
| Rate for Payer: Ohio Health Group HMO |
$47.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.63
|
| Rate for Payer: PHCS Commercial |
$60.78
|
| Rate for Payer: United Healthcare All Payer |
$55.71
|
|
|
HUMULIN 70/30 KWIKPEN
|
Facility
|
OP
|
$63.31
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25003751
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$60.78 |
| Rate for Payer: Aetna Commercial |
$48.75
|
| Rate for Payer: Anthem Medicaid |
$21.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.38
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cigna Commercial |
$52.55
|
| Rate for Payer: First Health Commercial |
$60.14
|
| Rate for Payer: Humana Commercial |
$53.81
|
| Rate for Payer: Humana KY Medicaid |
$21.77
|
| Rate for Payer: Kentucky WC Medicaid |
$21.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.71
|
| Rate for Payer: Ohio Health Group HMO |
$47.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.63
|
| Rate for Payer: PHCS Commercial |
$60.78
|
| Rate for Payer: United Healthcare All Payer |
$55.71
|
|
|
HUMULIN N 5u(1000unit/10mL)MDV
|
Facility
|
IP
|
$243.12
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$233.40 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.63
|
| Rate for Payer: Cash Price |
$121.56
|
| Rate for Payer: Cigna Commercial |
$201.79
|
| Rate for Payer: First Health Commercial |
$230.96
|
| Rate for Payer: Humana Commercial |
$206.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.95
|
| Rate for Payer: Ohio Health Group HMO |
$182.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.37
|
| Rate for Payer: PHCS Commercial |
$233.40
|
| Rate for Payer: United Healthcare All Payer |
$213.95
|
|
|
HUMULIN N 5u(1000unit/10mL)MDV
|
Facility
|
OP
|
$243.12
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004282
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$233.40 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.63
|
| Rate for Payer: Cash Price |
$121.56
|
| Rate for Payer: Cigna Commercial |
$201.79
|
| Rate for Payer: First Health Commercial |
$230.96
|
| Rate for Payer: Humana Commercial |
$206.65
|
| Rate for Payer: Humana KY Medicaid |
$83.61
|
| Rate for Payer: Kentucky WC Medicaid |
$84.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.95
|
| Rate for Payer: Ohio Health Group HMO |
$182.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.37
|
| Rate for Payer: PHCS Commercial |
$233.40
|
| Rate for Payer: United Healthcare All Payer |
$213.95
|
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Anthem Medicaid |
$83.61
|
|
|
HUMULIN N KWIKPEN
|
Facility
|
IP
|
$184.28
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004527
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$176.91 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.17
|
| Rate for Payer: Ohio Health Group HMO |
$138.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.13
|
| Rate for Payer: PHCS Commercial |
$176.91
|
| Rate for Payer: United Healthcare All Payer |
$162.17
|
| Rate for Payer: Aetna Commercial |
$141.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.74
|
| Rate for Payer: Cash Price |
$92.14
|
| Rate for Payer: Cigna Commercial |
$152.95
|
| Rate for Payer: First Health Commercial |
$175.07
|
| Rate for Payer: Humana Commercial |
$156.64
|
|
|
HUMULIN N KWIKPEN
|
Facility
|
OP
|
$184.28
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25004527
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$176.91 |
| Rate for Payer: Aetna Commercial |
$141.90
|
| Rate for Payer: Anthem Medicaid |
$63.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.74
|
| Rate for Payer: Cash Price |
$92.14
|
| Rate for Payer: Cigna Commercial |
$152.95
|
| Rate for Payer: First Health Commercial |
$175.07
|
| Rate for Payer: Humana Commercial |
$156.64
|
| Rate for Payer: Humana KY Medicaid |
$63.37
|
| Rate for Payer: Kentucky WC Medicaid |
$64.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$151.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$136.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$162.17
|
| Rate for Payer: Ohio Health Group HMO |
$138.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.13
|
| Rate for Payer: PHCS Commercial |
$176.91
|
| Rate for Payer: United Healthcare All Payer |
$162.17
|
|
|
HUMULIN R U 500 KWIKPEN (3ML)
|
Facility
|
OP
|
$63.19
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$60.66 |
| Rate for Payer: Aetna Commercial |
$48.66
|
| Rate for Payer: Anthem Medicaid |
$21.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.29
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: Cigna Commercial |
$52.45
|
| Rate for Payer: First Health Commercial |
$60.03
|
| Rate for Payer: Humana Commercial |
$53.71
|
| Rate for Payer: Humana KY Medicaid |
$21.73
|
| Rate for Payer: Kentucky WC Medicaid |
$21.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.61
|
| Rate for Payer: Ohio Health Group HMO |
$47.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.59
|
| Rate for Payer: PHCS Commercial |
$60.66
|
| Rate for Payer: United Healthcare All Payer |
$55.61
|
|
|
HUMULIN R U 500 KWIKPEN (3ML)
|
Facility
|
IP
|
$63.19
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002177
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$60.66 |
| Rate for Payer: Aetna Commercial |
$48.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.29
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: Cigna Commercial |
$52.45
|
| Rate for Payer: First Health Commercial |
$60.03
|
| Rate for Payer: Humana Commercial |
$53.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.61
|
| Rate for Payer: Ohio Health Group HMO |
$47.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.59
|
| Rate for Payer: PHCS Commercial |
$60.66
|
| Rate for Payer: United Healthcare All Payer |
$55.61
|
|
|
HYBRID GLEN BASE LG 4MM
|
Facility
|
OP
|
$8,293.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.12 |
| Max. Negotiated Rate |
$7,961.52 |
| Rate for Payer: Aetna Commercial |
$6,385.80
|
| Rate for Payer: Anthem Medicaid |
$2,852.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.74
|
| Rate for Payer: Cash Price |
$4,146.62
|
| Rate for Payer: Cigna Commercial |
$6,883.40
|
| Rate for Payer: First Health Commercial |
$7,878.59
|
| Rate for Payer: Humana Commercial |
$7,049.26
|
| Rate for Payer: Humana KY Medicaid |
$2,852.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,881.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,800.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,120.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,298.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,658.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.91
|
| Rate for Payer: PHCS Commercial |
$7,961.52
|
| Rate for Payer: United Healthcare All Payer |
$7,298.06
|
|
|
HYBRID GLEN BASE LG 4MM
|
Facility
|
IP
|
$8,293.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.12 |
| Max. Negotiated Rate |
$7,961.52 |
| Rate for Payer: Aetna Commercial |
$6,385.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.74
|
| Rate for Payer: Cash Price |
$4,146.62
|
| Rate for Payer: Cigna Commercial |
$6,883.40
|
| Rate for Payer: First Health Commercial |
$7,878.59
|
| Rate for Payer: Humana Commercial |
$7,049.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,800.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,120.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,298.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,658.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.91
|
| Rate for Payer: PHCS Commercial |
$7,961.52
|
| Rate for Payer: United Healthcare All Payer |
$7,298.06
|
|
|
HYBRID GLEN BASE MD 4MM
|
Facility
|
IP
|
$8,293.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.12 |
| Max. Negotiated Rate |
$7,961.52 |
| Rate for Payer: Aetna Commercial |
$6,385.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.74
|
| Rate for Payer: Cash Price |
$4,146.62
|
| Rate for Payer: Cigna Commercial |
$6,883.40
|
| Rate for Payer: First Health Commercial |
$7,878.59
|
| Rate for Payer: Humana Commercial |
$7,049.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,800.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,120.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,298.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,658.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.91
|
| Rate for Payer: PHCS Commercial |
$7,961.52
|
| Rate for Payer: United Healthcare All Payer |
$7,298.06
|
|
|
HYBRID GLEN BASE MD 4MM
|
Facility
|
OP
|
$8,293.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.12 |
| Max. Negotiated Rate |
$7,961.52 |
| Rate for Payer: Aetna Commercial |
$6,385.80
|
| Rate for Payer: Anthem Medicaid |
$2,852.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.74
|
| Rate for Payer: Cash Price |
$4,146.62
|
| Rate for Payer: Cigna Commercial |
$6,883.40
|
| Rate for Payer: First Health Commercial |
$7,878.59
|
| Rate for Payer: Humana Commercial |
$7,049.26
|
| Rate for Payer: Humana KY Medicaid |
$2,852.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,881.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,800.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,120.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,298.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,658.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.91
|
| Rate for Payer: PHCS Commercial |
$7,961.52
|
| Rate for Payer: United Healthcare All Payer |
$7,298.06
|
|
|
HYBRID GLEN BASE SM 4MM
|
Facility
|
IP
|
$8,293.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.12 |
| Max. Negotiated Rate |
$7,961.52 |
| Rate for Payer: Aetna Commercial |
$6,385.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.74
|
| Rate for Payer: Cash Price |
$4,146.62
|
| Rate for Payer: Cigna Commercial |
$6,883.40
|
| Rate for Payer: First Health Commercial |
$7,878.59
|
| Rate for Payer: Humana Commercial |
$7,049.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,800.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,120.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,298.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,658.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.91
|
| Rate for Payer: PHCS Commercial |
$7,961.52
|
| Rate for Payer: United Healthcare All Payer |
$7,298.06
|
|
|
HYBRID GLEN BASE SM 4MM
|
Facility
|
OP
|
$8,293.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.12 |
| Max. Negotiated Rate |
$7,961.52 |
| Rate for Payer: Aetna Commercial |
$6,385.80
|
| Rate for Payer: Anthem Medicaid |
$2,852.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.74
|
| Rate for Payer: Cash Price |
$4,146.62
|
| Rate for Payer: Cigna Commercial |
$6,883.40
|
| Rate for Payer: First Health Commercial |
$7,878.59
|
| Rate for Payer: Humana Commercial |
$7,049.26
|
| Rate for Payer: Humana KY Medicaid |
$2,852.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,881.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,800.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,120.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,298.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,658.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.91
|
| Rate for Payer: PHCS Commercial |
$7,961.52
|
| Rate for Payer: United Healthcare All Payer |
$7,298.06
|
|
|
HYCAMTIN 0.1 MG ( 4MG VIAL)
|
Facility
|
IP
|
$1,280.75
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
25002683
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$1,229.52 |
| Rate for Payer: Aetna Commercial |
$986.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.98
|
| Rate for Payer: Cash Price |
$640.38
|
| Rate for Payer: Cigna Commercial |
$1,063.02
|
| Rate for Payer: First Health Commercial |
$1,216.71
|
| Rate for Payer: Humana Commercial |
$1,088.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,050.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$945.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,127.06
|
| Rate for Payer: Ohio Health Group HMO |
$960.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$397.03
|
| Rate for Payer: PHCS Commercial |
$1,229.52
|
| Rate for Payer: United Healthcare All Payer |
$1,127.06
|
|
|
HYCAMTIN 0.1 MG ( 4MG VIAL)
|
Facility
|
OP
|
$1,280.75
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
25002683
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$1,229.52 |
| Rate for Payer: Aetna Commercial |
$986.18
|
| Rate for Payer: Anthem Medicaid |
$440.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.98
|
| Rate for Payer: Cash Price |
$640.38
|
| Rate for Payer: Cigna Commercial |
$1,063.02
|
| Rate for Payer: First Health Commercial |
$1,216.71
|
| Rate for Payer: Humana Commercial |
$1,088.64
|
| Rate for Payer: Humana KY Medicaid |
$440.45
|
| Rate for Payer: Kentucky WC Medicaid |
$444.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,050.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$945.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,127.06
|
| Rate for Payer: Ohio Health Group HMO |
$960.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$397.03
|
| Rate for Payer: PHCS Commercial |
$1,229.52
|
| Rate for Payer: United Healthcare All Payer |
$1,127.06
|
|
|
HYDRATING CLEANSER 200 ML GBL
|
Professional
|
Both
|
$45.00
|
|
| Hospital Charge Code |
22200141
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
|
|
HYDRATION ADDL HRS EA
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna Commercial |
$25.71
|
| Rate for Payer: Anthem Medicaid |
$13.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$22.41
|
| Rate for Payer: Healthspan PPO |
$24.09
|
| Rate for Payer: Humana Medicaid |
$13.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$13.31
|
| Rate for Payer: Molina Healthcare Passport |
$13.05
|
| Rate for Payer: Multiplan PHCS |
$121.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$141.40
|
| Rate for Payer: UHCCP Medicaid |
$70.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$13.18
|
|
|
HYDRATION ADDL HRS EA
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$193.92 |
| Rate for Payer: Aetna Commercial |
$155.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$157.56
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$167.66
|
| Rate for Payer: First Health Commercial |
$191.90
|
| Rate for Payer: Humana Commercial |
$171.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.76
|
| Rate for Payer: Ohio Health Group HMO |
$151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.62
|
| Rate for Payer: PHCS Commercial |
$193.92
|
| Rate for Payer: United Healthcare All Payer |
$177.76
|
|
|
HYDRATION ADDL HRS EA
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$193.92 |
| Rate for Payer: Aetna Commercial |
$155.54
|
| Rate for Payer: Anthem Medicaid |
$69.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$157.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.46
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$167.66
|
| Rate for Payer: First Health Commercial |
$191.90
|
| Rate for Payer: Humana Commercial |
$171.70
|
| Rate for Payer: Humana KY Medicaid |
$69.47
|
| Rate for Payer: Humana Medicare Advantage |
$41.08
|
| Rate for Payer: Kentucky WC Medicaid |
$70.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.76
|
| Rate for Payer: Ohio Health Group HMO |
$151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.62
|
| Rate for Payer: PHCS Commercial |
$193.92
|
| Rate for Payer: United Healthcare All Payer |
$177.76
|
|
|
HYDRATION INIT INFUS 1HR
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna Commercial |
$85.98
|
| Rate for Payer: Anthem Medicaid |
$45.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$364.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$75.95
|
| Rate for Payer: Healthspan PPO |
$80.56
|
| Rate for Payer: Humana Medicaid |
$45.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.31
|
| Rate for Payer: Molina Healthcare Passport |
$45.40
|
| Rate for Payer: Multiplan PHCS |
$218.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$254.80
|
| Rate for Payer: UHCCP Medicaid |
$127.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.85
|
|
|
HYDRATION INIT INFUS 1HR
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$47.32 |
| Max. Negotiated Rate |
$349.44 |
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cigna Commercial |
$302.12
|
| Rate for Payer: First Health Commercial |
$345.80
|
| Rate for Payer: Humana Commercial |
$309.40
|
| Rate for Payer: Humana KY Medicaid |
$125.18
|
| Rate for Payer: Humana Medicare Advantage |
$185.35
|
| Rate for Payer: Kentucky WC Medicaid |
$126.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$298.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$268.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$127.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$320.32
|
| Rate for Payer: Ohio Health Group HMO |
$273.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.84
|
| Rate for Payer: PHCS Commercial |
$349.44
|
| Rate for Payer: United Healthcare All Payer |
$320.32
|
| Rate for Payer: Aetna Commercial |
$280.28
|
| Rate for Payer: Anthem Medicaid |
$125.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$283.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$259.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.22
|
|
