|
[C]MORPHINE(GEN) 2MG/1ML
|
Facility
|
OP
|
$77.13
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Anthem Medicaid |
$26.53
|
| Rate for Payer: Anthem Medicaid |
$26.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.74
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cigna Commercial |
$64.63
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: First Health Commercial |
$73.98
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Humana Commercial |
$66.19
|
| Rate for Payer: Humana KY Medicaid |
$26.53
|
| Rate for Payer: Humana KY Medicaid |
$26.78
|
| Rate for Payer: Kentucky WC Medicaid |
$27.05
|
| Rate for Payer: Kentucky WC Medicaid |
$26.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.53
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group HMO |
$58.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.73
|
| Rate for Payer: PHCS Commercial |
$74.76
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: United Healthcare All Payer |
$68.53
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
|
|
[C]MORPHINE(GEN) 2MG/1ML
|
Facility
|
IP
|
$77.13
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.74
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: Cigna Commercial |
$64.63
|
| Rate for Payer: First Health Commercial |
$73.98
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$66.19
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.53
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group HMO |
$58.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.22
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: PHCS Commercial |
$74.76
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
| Rate for Payer: United Healthcare All Payer |
$68.53
|
|
|
[C]MORPHINE(GEN) 4MG/1ML
|
Facility
|
OP
|
$76.95
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Anthem Medicaid |
$26.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.02
|
| Rate for Payer: Cash Price |
$38.48
|
| Rate for Payer: Cigna Commercial |
$63.87
|
| Rate for Payer: First Health Commercial |
$73.10
|
| Rate for Payer: Humana Commercial |
$65.41
|
| Rate for Payer: Humana KY Medicaid |
$26.46
|
| Rate for Payer: Kentucky WC Medicaid |
$26.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.72
|
| Rate for Payer: Ohio Health Group HMO |
$57.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.10
|
| Rate for Payer: PHCS Commercial |
$73.87
|
| Rate for Payer: United Healthcare All Payer |
$67.72
|
|
|
[C]MORPHINE(GEN) 4MG/1ML
|
Facility
|
IP
|
$76.95
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.02
|
| Rate for Payer: Cash Price |
$38.48
|
| Rate for Payer: Cigna Commercial |
$63.87
|
| Rate for Payer: First Health Commercial |
$73.10
|
| Rate for Payer: Humana Commercial |
$65.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.72
|
| Rate for Payer: Ohio Health Group HMO |
$57.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.10
|
| Rate for Payer: PHCS Commercial |
$73.87
|
| Rate for Payer: United Healthcare All Payer |
$67.72
|
|
|
[C]MORPHINE SULFATE(R 10MG/1EA
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
NDC 574711212
|
| Hospital Charge Code |
25000108
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.70
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
[C]MORPHINE SULFATE(R 10MG/1EA
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
NDC 574711212
|
| Hospital Charge Code |
25000108
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$22.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.70
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$22.35
|
| Rate for Payer: Kentucky WC Medicaid |
$22.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.85
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
CMPR RVS SHLDR GLEN BASEPLT
|
Facility
|
IP
|
$11,764.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,529.45 |
| Max. Negotiated Rate |
$11,294.25 |
| Rate for Payer: Aetna Commercial |
$9,058.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,176.58
|
| Rate for Payer: Cash Price |
$5,882.42
|
| Rate for Payer: Cigna Commercial |
$9,764.82
|
| Rate for Payer: First Health Commercial |
$11,176.60
|
| Rate for Payer: Humana Commercial |
$10,000.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,647.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,682.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,529.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,353.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,823.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,411.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,235.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,117.74
|
| Rate for Payer: PHCS Commercial |
$11,294.25
|
| Rate for Payer: United Healthcare All Payer |
$10,353.06
|
|
|
CMPR RVS SHLDR GLEN BASEPLT
|
Facility
|
OP
|
$11,764.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,529.45 |
| Max. Negotiated Rate |
$11,294.25 |
| Rate for Payer: Aetna Commercial |
$9,058.93
|
| Rate for Payer: Anthem Medicaid |
$4,045.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,176.58
|
| Rate for Payer: Cash Price |
$5,882.42
|
| Rate for Payer: Cigna Commercial |
$9,764.82
|
| Rate for Payer: First Health Commercial |
$11,176.60
|
| Rate for Payer: Humana Commercial |
$10,000.11
|
| Rate for Payer: Humana KY Medicaid |
$4,045.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,087.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,647.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,682.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,529.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,127.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,353.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,823.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,411.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,235.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,117.74
|
| Rate for Payer: PHCS Commercial |
$11,294.25
|
| Rate for Payer: United Healthcare All Payer |
$10,353.06
|
|
|
CMPR RVS SHLDR GLEN BASPLT MIN
|
Facility
|
OP
|
$10,219.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,065.91 |
| Max. Negotiated Rate |
$9,810.91 |
| Rate for Payer: Aetna Commercial |
$7,869.17
|
| Rate for Payer: Anthem Medicaid |
$3,514.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,971.37
|
| Rate for Payer: Cash Price |
$5,109.85
|
| Rate for Payer: Cigna Commercial |
$8,482.35
|
| Rate for Payer: First Health Commercial |
$9,708.72
|
| Rate for Payer: Humana Commercial |
$8,686.75
|
| Rate for Payer: Humana KY Medicaid |
$3,514.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,550.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,380.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,542.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,065.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,585.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,993.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,664.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,175.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,891.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,051.59
|
| Rate for Payer: PHCS Commercial |
$9,810.91
|
| Rate for Payer: United Healthcare All Payer |
$8,993.34
|
|
|
CMPR RVS SHLDR GLEN BASPLT MIN
|
Facility
|
IP
|
$10,219.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,065.91 |
| Max. Negotiated Rate |
$9,810.91 |
| Rate for Payer: Aetna Commercial |
$7,869.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,971.37
|
| Rate for Payer: Cash Price |
$5,109.85
|
| Rate for Payer: Cigna Commercial |
$8,482.35
|
| Rate for Payer: First Health Commercial |
$9,708.72
|
| Rate for Payer: Humana Commercial |
$8,686.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,380.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,542.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,065.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,993.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,664.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,175.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,891.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,051.59
|
| Rate for Payer: PHCS Commercial |
$9,810.91
|
| Rate for Payer: United Healthcare All Payer |
$8,993.34
|
|
|
CMPR RVS SHLDR GLENSPR 36M STD
|
Facility
|
OP
|
$9,632.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,889.61 |
| Max. Negotiated Rate |
$9,246.77 |
| Rate for Payer: Aetna Commercial |
$7,416.68
|
| Rate for Payer: Anthem Medicaid |
$3,312.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,513.00
|
| Rate for Payer: Cash Price |
$4,816.02
|
| Rate for Payer: Cigna Commercial |
$7,994.60
|
| Rate for Payer: First Health Commercial |
$9,150.45
|
| Rate for Payer: Humana Commercial |
$8,187.24
|
| Rate for Payer: Humana KY Medicaid |
$3,312.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,898.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,108.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,889.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,378.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,476.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,224.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,705.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,379.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,646.11
|
| Rate for Payer: PHCS Commercial |
$9,246.77
|
| Rate for Payer: United Healthcare All Payer |
$8,476.20
|
|
|
CMPR RVS SHLDR GLENSPR 36M STD
|
Facility
|
IP
|
$9,632.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,889.61 |
| Max. Negotiated Rate |
$9,246.77 |
| Rate for Payer: Aetna Commercial |
$7,416.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,513.00
|
| Rate for Payer: Cash Price |
$4,816.02
|
| Rate for Payer: Cigna Commercial |
$7,994.60
|
| Rate for Payer: First Health Commercial |
$9,150.45
|
| Rate for Payer: Humana Commercial |
$8,187.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,898.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,108.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,889.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,476.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,224.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,705.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,379.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,646.11
|
| Rate for Payer: PHCS Commercial |
$9,246.77
|
| Rate for Payer: United Healthcare All Payer |
$8,476.20
|
|
|
CMPR RVS SHLDR GLENSPR 41M STD
|
Facility
|
IP
|
$9,285.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,785.59 |
| Max. Negotiated Rate |
$8,913.89 |
| Rate for Payer: Aetna Commercial |
$7,149.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,242.53
|
| Rate for Payer: Cash Price |
$4,642.65
|
| Rate for Payer: Cigna Commercial |
$7,706.80
|
| Rate for Payer: First Health Commercial |
$8,821.03
|
| Rate for Payer: Humana Commercial |
$7,892.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,613.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,852.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,785.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,171.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,963.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,428.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,078.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,406.86
|
| Rate for Payer: PHCS Commercial |
$8,913.89
|
| Rate for Payer: United Healthcare All Payer |
$8,171.06
|
|
|
CMPR RVS SHLDR GLENSPR 41M STD
|
Facility
|
OP
|
$9,285.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,785.59 |
| Max. Negotiated Rate |
$8,913.89 |
| Rate for Payer: Aetna Commercial |
$7,149.68
|
| Rate for Payer: Anthem Medicaid |
$3,193.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,242.53
|
| Rate for Payer: Cash Price |
$4,642.65
|
| Rate for Payer: Cigna Commercial |
$7,706.80
|
| Rate for Payer: First Health Commercial |
$8,821.03
|
| Rate for Payer: Humana Commercial |
$7,892.51
|
| Rate for Payer: Humana KY Medicaid |
$3,193.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,225.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,613.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,852.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,785.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,257.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,171.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,963.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,428.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,078.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,406.86
|
| Rate for Payer: PHCS Commercial |
$8,913.89
|
| Rate for Payer: United Healthcare All Payer |
$8,171.06
|
|
|
[C]MS CONTIN (MORP 200MG/1TAB
|
Facility
|
IP
|
$66.74
|
|
|
Service Code
|
NDC 406832001
|
| Hospital Charge Code |
25000077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$64.07 |
| Rate for Payer: Aetna Commercial |
$51.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.06
|
| Rate for Payer: Cash Price |
$33.37
|
| Rate for Payer: Cigna Commercial |
$55.39
|
| Rate for Payer: First Health Commercial |
$63.40
|
| Rate for Payer: Humana Commercial |
$56.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.73
|
| Rate for Payer: Ohio Health Group HMO |
$50.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.05
|
| Rate for Payer: PHCS Commercial |
$64.07
|
| Rate for Payer: United Healthcare All Payer |
$58.73
|
|
|
[C]MS CONTIN (MORP 200MG/1TAB
|
Facility
|
OP
|
$66.74
|
|
|
Service Code
|
NDC 406832001
|
| Hospital Charge Code |
25000077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$64.07 |
| Rate for Payer: Aetna Commercial |
$51.39
|
| Rate for Payer: Anthem Medicaid |
$22.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.06
|
| Rate for Payer: Cash Price |
$33.37
|
| Rate for Payer: Cigna Commercial |
$55.39
|
| Rate for Payer: First Health Commercial |
$63.40
|
| Rate for Payer: Humana Commercial |
$56.73
|
| Rate for Payer: Humana KY Medicaid |
$22.95
|
| Rate for Payer: Kentucky WC Medicaid |
$23.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.73
|
| Rate for Payer: Ohio Health Group HMO |
$50.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.05
|
| Rate for Payer: PHCS Commercial |
$64.07
|
| Rate for Payer: United Healthcare All Payer |
$58.73
|
|
|
[C]MS CONTIN (MORPH 100MG/1TAB
|
Facility
|
IP
|
$63.68
|
|
|
Service Code
|
NDC 406839001
|
| Hospital Charge Code |
25000109
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$49.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.67
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cigna Commercial |
$52.85
|
| Rate for Payer: First Health Commercial |
$60.50
|
| Rate for Payer: Humana Commercial |
$54.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.04
|
| Rate for Payer: Ohio Health Group HMO |
$47.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.94
|
| Rate for Payer: PHCS Commercial |
$61.13
|
| Rate for Payer: United Healthcare All Payer |
$56.04
|
|
|
[C]MS CONTIN (MORPH 100MG/1TAB
|
Facility
|
OP
|
$63.68
|
|
|
Service Code
|
NDC 406839001
|
| Hospital Charge Code |
25000109
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$49.03
|
| Rate for Payer: Anthem Medicaid |
$21.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.67
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cigna Commercial |
$52.85
|
| Rate for Payer: First Health Commercial |
$60.50
|
| Rate for Payer: Humana Commercial |
$54.13
|
| Rate for Payer: Humana KY Medicaid |
$21.90
|
| Rate for Payer: Kentucky WC Medicaid |
$22.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.04
|
| Rate for Payer: Ohio Health Group HMO |
$47.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.94
|
| Rate for Payer: PHCS Commercial |
$61.13
|
| Rate for Payer: United Healthcare All Payer |
$56.04
|
|
|
[C]MS CONTIN(MORPHIN 15MG/1TAB
|
Facility
|
IP
|
$60.67
|
|
|
Service Code
|
NDC 406831501
|
| Hospital Charge Code |
25000110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$58.24 |
| Rate for Payer: Aetna Commercial |
$46.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.32
|
| Rate for Payer: Cash Price |
$30.34
|
| Rate for Payer: Cigna Commercial |
$50.36
|
| Rate for Payer: First Health Commercial |
$57.64
|
| Rate for Payer: Humana Commercial |
$51.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.39
|
| Rate for Payer: Ohio Health Group HMO |
$45.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.86
|
| Rate for Payer: PHCS Commercial |
$58.24
|
| Rate for Payer: United Healthcare All Payer |
$53.39
|
|
|
[C]MS CONTIN(MORPHIN 15MG/1TAB
|
Facility
|
OP
|
$60.67
|
|
|
Service Code
|
NDC 406831501
|
| Hospital Charge Code |
25000110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$58.24 |
| Rate for Payer: Aetna Commercial |
$46.72
|
| Rate for Payer: Anthem Medicaid |
$20.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.32
|
| Rate for Payer: Cash Price |
$30.34
|
| Rate for Payer: Cigna Commercial |
$50.36
|
| Rate for Payer: First Health Commercial |
$57.64
|
| Rate for Payer: Humana Commercial |
$51.57
|
| Rate for Payer: Humana KY Medicaid |
$20.86
|
| Rate for Payer: Kentucky WC Medicaid |
$21.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.39
|
| Rate for Payer: Ohio Health Group HMO |
$45.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.86
|
| Rate for Payer: PHCS Commercial |
$58.24
|
| Rate for Payer: United Healthcare All Payer |
$53.39
|
|
|
[C]MS CONTIN(MORPHIN 30MG/1TAB
|
Facility
|
IP
|
$61.27
|
|
|
Service Code
|
NDC 406833001
|
| Hospital Charge Code |
25000111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.79
|
| Rate for Payer: Cash Price |
$30.64
|
| Rate for Payer: Cigna Commercial |
$50.85
|
| Rate for Payer: First Health Commercial |
$58.21
|
| Rate for Payer: Humana Commercial |
$52.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.92
|
| Rate for Payer: Ohio Health Group HMO |
$45.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.28
|
| Rate for Payer: PHCS Commercial |
$58.82
|
| Rate for Payer: United Healthcare All Payer |
$53.92
|
|
|
[C]MS CONTIN(MORPHIN 30MG/1TAB
|
Facility
|
OP
|
$61.27
|
|
|
Service Code
|
NDC 406833001
|
| Hospital Charge Code |
25000111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: Anthem Medicaid |
$21.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.79
|
| Rate for Payer: Cash Price |
$30.64
|
| Rate for Payer: Cigna Commercial |
$50.85
|
| Rate for Payer: First Health Commercial |
$58.21
|
| Rate for Payer: Humana Commercial |
$52.08
|
| Rate for Payer: Humana KY Medicaid |
$21.07
|
| Rate for Payer: Kentucky WC Medicaid |
$21.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.92
|
| Rate for Payer: Ohio Health Group HMO |
$45.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.28
|
| Rate for Payer: PHCS Commercial |
$58.82
|
| Rate for Payer: United Healthcare All Payer |
$53.92
|
|
|
[C]MS CONTIN(MORPHIN 60MG/1TAB
|
Facility
|
OP
|
$60.87
|
|
|
Service Code
|
NDC 42858080301
|
| Hospital Charge Code |
25000112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$58.44 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Anthem Medicaid |
$20.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.48
|
| Rate for Payer: Cash Price |
$30.43
|
| Rate for Payer: Cigna Commercial |
$50.52
|
| Rate for Payer: First Health Commercial |
$57.83
|
| Rate for Payer: Humana Commercial |
$51.74
|
| Rate for Payer: Humana KY Medicaid |
$20.93
|
| Rate for Payer: Kentucky WC Medicaid |
$21.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.57
|
| Rate for Payer: Ohio Health Group HMO |
$45.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.00
|
| Rate for Payer: PHCS Commercial |
$58.44
|
| Rate for Payer: United Healthcare All Payer |
$53.57
|
|
|
[C]MS CONTIN(MORPHIN 60MG/1TAB
|
Facility
|
IP
|
$60.87
|
|
|
Service Code
|
NDC 42858080301
|
| Hospital Charge Code |
25000112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$58.44 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.48
|
| Rate for Payer: Cash Price |
$30.43
|
| Rate for Payer: Cigna Commercial |
$50.52
|
| Rate for Payer: First Health Commercial |
$57.83
|
| Rate for Payer: Humana Commercial |
$51.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.57
|
| Rate for Payer: Ohio Health Group HMO |
$45.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.00
|
| Rate for Payer: PHCS Commercial |
$58.44
|
| Rate for Payer: United Healthcare All Payer |
$53.57
|
|
|
[C]MSIR (MORPHINE S 15MG/TAB0
|
Facility
|
IP
|
$60.43
|
|
|
Service Code
|
NDC 54023525
|
| Hospital Charge Code |
25000078
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$58.01 |
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.14
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cigna Commercial |
$50.16
|
| Rate for Payer: First Health Commercial |
$57.41
|
| Rate for Payer: Humana Commercial |
$51.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.18
|
| Rate for Payer: Ohio Health Group HMO |
$45.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.70
|
| Rate for Payer: PHCS Commercial |
$58.01
|
| Rate for Payer: United Healthcare All Payer |
$53.18
|
|
