|
MAGNESIUM SULFATE 1GM/2ML VIAL
|
Facility
|
OP
|
$77.58
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$74.48 |
| Rate for Payer: Aetna Commercial |
$59.74
|
| Rate for Payer: Aetna Commercial |
$60.27
|
| Rate for Payer: Anthem Medicaid |
$26.68
|
| Rate for Payer: Anthem Medicaid |
$26.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.05
|
| Rate for Payer: Cash Price |
$38.79
|
| Rate for Payer: Cash Price |
$39.13
|
| Rate for Payer: Cigna Commercial |
$64.96
|
| Rate for Payer: Cigna Commercial |
$64.39
|
| Rate for Payer: First Health Commercial |
$74.36
|
| Rate for Payer: First Health Commercial |
$73.70
|
| Rate for Payer: Humana Commercial |
$65.94
|
| Rate for Payer: Humana Commercial |
$66.53
|
| Rate for Payer: Humana KY Medicaid |
$26.68
|
| Rate for Payer: Humana KY Medicaid |
$26.92
|
| Rate for Payer: Kentucky WC Medicaid |
$27.19
|
| Rate for Payer: Kentucky WC Medicaid |
$26.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.88
|
| Rate for Payer: Ohio Health Group HMO |
$58.18
|
| Rate for Payer: Ohio Health Group HMO |
$58.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.26
|
| Rate for Payer: PHCS Commercial |
$75.14
|
| Rate for Payer: PHCS Commercial |
$74.48
|
| Rate for Payer: United Healthcare All Payer |
$68.88
|
| Rate for Payer: United Healthcare All Payer |
$68.27
|
|
|
MAGNESIUM SULFATE 1GM/2ML VIAL
|
Facility
|
IP
|
$77.58
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$74.48 |
| Rate for Payer: Aetna Commercial |
$59.74
|
| Rate for Payer: Aetna Commercial |
$60.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.05
|
| Rate for Payer: Cash Price |
$38.79
|
| Rate for Payer: Cash Price |
$39.13
|
| Rate for Payer: Cigna Commercial |
$64.39
|
| Rate for Payer: Cigna Commercial |
$64.96
|
| Rate for Payer: First Health Commercial |
$74.36
|
| Rate for Payer: First Health Commercial |
$73.70
|
| Rate for Payer: Humana Commercial |
$66.53
|
| Rate for Payer: Humana Commercial |
$65.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.88
|
| Rate for Payer: Ohio Health Group HMO |
$58.18
|
| Rate for Payer: Ohio Health Group HMO |
$58.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.05
|
| Rate for Payer: PHCS Commercial |
$74.48
|
| Rate for Payer: PHCS Commercial |
$75.14
|
| Rate for Payer: United Healthcare All Payer |
$68.27
|
| Rate for Payer: United Healthcare All Payer |
$68.88
|
|
|
MAGNESIUM SULFATE 4GM/100ML IV
|
Facility
|
IP
|
$79.52
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Aetna Commercial |
$61.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.03
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cigna Commercial |
$66.00
|
| Rate for Payer: First Health Commercial |
$75.54
|
| Rate for Payer: Humana Commercial |
$67.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.98
|
| Rate for Payer: Ohio Health Group HMO |
$59.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.65
|
| Rate for Payer: PHCS Commercial |
$76.34
|
| Rate for Payer: United Healthcare All Payer |
$69.98
|
|
|
MAGNESIUM SULFATE 4GM/100ML IV
|
Facility
|
OP
|
$79.52
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
25002439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Aetna Commercial |
$61.23
|
| Rate for Payer: Anthem Medicaid |
$27.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.03
|
| Rate for Payer: Cash Price |
$39.76
|
| Rate for Payer: Cigna Commercial |
$66.00
|
| Rate for Payer: First Health Commercial |
$75.54
|
| Rate for Payer: Humana Commercial |
$67.59
|
| Rate for Payer: Humana KY Medicaid |
$27.35
|
| Rate for Payer: Kentucky WC Medicaid |
$27.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.98
|
| Rate for Payer: Ohio Health Group HMO |
$59.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.65
|
| Rate for Payer: PHCS Commercial |
$76.34
|
| Rate for Payer: United Healthcare All Payer |
$69.98
|
|
|
MAGNETIC RESONANCE SPECTRO
|
Professional
|
Both
|
$2,674.00
|
|
|
Service Code
|
HCPCS 76390
|
| Hospital Charge Code |
61000047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.95 |
| Max. Negotiated Rate |
$2,674.00 |
| Rate for Payer: Aetna Commercial |
$702.60
|
| Rate for Payer: Anthem Medicaid |
$351.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,674.00
|
| Rate for Payer: Cash Price |
$1,337.00
|
| Rate for Payer: Cash Price |
$1,337.00
|
| Rate for Payer: Cigna Commercial |
$715.05
|
| Rate for Payer: Healthspan PPO |
$472.86
|
| Rate for Payer: Humana Medicaid |
$351.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$359.00
|
| Rate for Payer: Molina Healthcare Passport |
$351.96
|
| Rate for Payer: Multiplan PHCS |
$1,604.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,871.80
|
| Rate for Payer: UHCCP Medicaid |
$935.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.48
|
|
|
MAGNETIC RESONANCE SPECTRO
|
Facility
|
IP
|
$2,674.00
|
|
|
Service Code
|
HCPCS 76390
|
| Hospital Charge Code |
61000047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$347.62 |
| Max. Negotiated Rate |
$2,567.04 |
| Rate for Payer: Aetna Commercial |
$2,058.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,085.72
|
| Rate for Payer: Cash Price |
$1,337.00
|
| Rate for Payer: Cigna Commercial |
$2,219.42
|
| Rate for Payer: First Health Commercial |
$2,540.30
|
| Rate for Payer: Humana Commercial |
$2,272.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,192.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,973.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$802.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,353.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,005.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$534.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$347.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.94
|
| Rate for Payer: PHCS Commercial |
$2,567.04
|
| Rate for Payer: United Healthcare All Payer |
$2,353.12
|
|
|
MAGNETIC RESONANCE SPECTRO
|
Facility
|
OP
|
$2,674.00
|
|
|
Service Code
|
HCPCS 76390
|
| Hospital Charge Code |
61000047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$2,567.04 |
| Rate for Payer: Aetna Commercial |
$2,058.98
|
| Rate for Payer: Anthem Medicaid |
$919.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,085.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$1,337.00
|
| Rate for Payer: Cash Price |
$1,337.00
|
| Rate for Payer: Cigna Commercial |
$2,219.42
|
| Rate for Payer: First Health Commercial |
$2,540.30
|
| Rate for Payer: Humana Commercial |
$2,272.90
|
| Rate for Payer: Humana KY Medicaid |
$919.59
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$928.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,192.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,973.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$938.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,353.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,005.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$534.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$347.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.94
|
| Rate for Payer: PHCS Commercial |
$2,567.04
|
| Rate for Payer: United Healthcare All Payer |
$2,353.12
|
|
|
MAGNETIC RESONANCE SPECTRO(P
|
Professional
|
Both
|
$200.00
|
|
| Hospital Charge Code |
610P0047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
|
|
MAGNETIC RESONANCE SPECTRO(T
|
Facility
|
IP
|
$2,474.00
|
|
|
Service Code
|
HCPCS 76390
|
| Hospital Charge Code |
610T0047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$321.62 |
| Max. Negotiated Rate |
$2,375.04 |
| Rate for Payer: Aetna Commercial |
$1,904.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,929.72
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cigna Commercial |
$2,053.42
|
| Rate for Payer: First Health Commercial |
$2,350.30
|
| Rate for Payer: Humana Commercial |
$2,102.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,028.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,825.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,177.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,855.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$766.94
|
| Rate for Payer: PHCS Commercial |
$2,375.04
|
| Rate for Payer: United Healthcare All Payer |
$2,177.12
|
|
|
MAGNETIC RESONANCE SPECTRO(T
|
Facility
|
OP
|
$2,474.00
|
|
|
Service Code
|
HCPCS 76390
|
| Hospital Charge Code |
610T0047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$2,375.04 |
| Rate for Payer: Aetna Commercial |
$1,904.98
|
| Rate for Payer: Anthem Medicaid |
$850.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,929.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cash Price |
$1,237.00
|
| Rate for Payer: Cigna Commercial |
$2,053.42
|
| Rate for Payer: First Health Commercial |
$2,350.30
|
| Rate for Payer: Humana Commercial |
$2,102.90
|
| Rate for Payer: Humana KY Medicaid |
$850.81
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$859.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,028.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,825.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$867.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,177.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,855.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$766.94
|
| Rate for Payer: PHCS Commercial |
$2,375.04
|
| Rate for Payer: United Healthcare All Payer |
$2,177.12
|
|
|
MAGNUM 2 KNOTLESS IMPLANT
|
Facility
|
IP
|
$3,313.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.81 |
| Max. Negotiated Rate |
$3,181.39 |
| Rate for Payer: Aetna Commercial |
$2,551.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,584.88
|
| Rate for Payer: Cash Price |
$1,656.97
|
| Rate for Payer: Cigna Commercial |
$2,750.58
|
| Rate for Payer: First Health Commercial |
$3,148.25
|
| Rate for Payer: Humana Commercial |
$2,816.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,717.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,445.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,916.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,485.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,027.32
|
| Rate for Payer: PHCS Commercial |
$3,181.39
|
| Rate for Payer: United Healthcare All Payer |
$2,916.28
|
|
|
MAGNUM 2 KNOTLESS IMPLANT
|
Facility
|
OP
|
$3,313.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.81 |
| Max. Negotiated Rate |
$3,181.39 |
| Rate for Payer: Aetna Commercial |
$2,551.74
|
| Rate for Payer: Anthem Medicaid |
$1,139.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,584.88
|
| Rate for Payer: Cash Price |
$1,656.97
|
| Rate for Payer: Cigna Commercial |
$2,750.58
|
| Rate for Payer: First Health Commercial |
$3,148.25
|
| Rate for Payer: Humana Commercial |
$2,816.86
|
| Rate for Payer: Humana KY Medicaid |
$1,139.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,151.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,717.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,445.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,916.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,485.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,027.32
|
| Rate for Payer: PHCS Commercial |
$3,181.39
|
| Rate for Payer: United Healthcare All Payer |
$2,916.28
|
|
|
MAGONATE(MAGNESIUM GLUCONA 5ML
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 187526701
|
| Hospital Charge Code |
25000939
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
MAGONATE(MAGNESIUM GLUCONA 5ML
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 187526701
|
| Hospital Charge Code |
25000939
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.58
|
| Rate for Payer: First Health Commercial |
$4.09
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.79
|
| Rate for Payer: Ohio Health Group HMO |
$3.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Payer |
$3.79
|
|
|
MAG-OX (MAGNESIUM O 400MG/1TAB
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 603020922
|
| Hospital Charge Code |
25000940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.51
|
| Rate for Payer: First Health Commercial |
$4.02
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.72
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.06
|
| Rate for Payer: United Healthcare All Payer |
$3.72
|
|
|
MAG-OX (MAGNESIUM O 400MG/1TAB
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 603020922
|
| Hospital Charge Code |
25000940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.30
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.51
|
| Rate for Payer: First Health Commercial |
$4.02
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.72
|
| Rate for Payer: Ohio Health Group HMO |
$3.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.06
|
| Rate for Payer: United Healthcare All Payer |
$3.72
|
|
|
MAGSEED 18G 12CM PART# 052511
|
Facility
|
IP
|
$2,308.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27000265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.04 |
| Max. Negotiated Rate |
$2,215.68 |
| Rate for Payer: Aetna Commercial |
$1,777.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,800.24
|
| Rate for Payer: Cash Price |
$1,154.00
|
| Rate for Payer: Cigna Commercial |
$1,915.64
|
| Rate for Payer: First Health Commercial |
$2,192.60
|
| Rate for Payer: Humana Commercial |
$1,961.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,892.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,703.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,031.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,731.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$461.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$715.48
|
| Rate for Payer: PHCS Commercial |
$2,215.68
|
| Rate for Payer: United Healthcare All Payer |
$2,031.04
|
|
|
MAGSEED 18G 12CM PART# 052511
|
Facility
|
OP
|
$2,308.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27000265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.04 |
| Max. Negotiated Rate |
$2,215.68 |
| Rate for Payer: Aetna Commercial |
$1,777.16
|
| Rate for Payer: Anthem Medicaid |
$793.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,800.24
|
| Rate for Payer: Cash Price |
$1,154.00
|
| Rate for Payer: Cigna Commercial |
$1,915.64
|
| Rate for Payer: First Health Commercial |
$2,192.60
|
| Rate for Payer: Humana Commercial |
$1,961.80
|
| Rate for Payer: Humana KY Medicaid |
$793.72
|
| Rate for Payer: Kentucky WC Medicaid |
$801.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,892.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,703.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$809.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,031.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,731.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$461.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$715.48
|
| Rate for Payer: PHCS Commercial |
$2,215.68
|
| Rate for Payer: United Healthcare All Payer |
$2,031.04
|
|
|
MAGSEED 18GM 7CM PART# 052617
|
Facility
|
OP
|
$2,308.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.04 |
| Max. Negotiated Rate |
$2,215.68 |
| Rate for Payer: Aetna Commercial |
$1,777.16
|
| Rate for Payer: Anthem Medicaid |
$793.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,800.24
|
| Rate for Payer: Cash Price |
$1,154.00
|
| Rate for Payer: Cigna Commercial |
$1,915.64
|
| Rate for Payer: First Health Commercial |
$2,192.60
|
| Rate for Payer: Humana Commercial |
$1,961.80
|
| Rate for Payer: Humana KY Medicaid |
$793.72
|
| Rate for Payer: Kentucky WC Medicaid |
$801.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,892.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,703.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$809.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,031.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,731.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$461.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$715.48
|
| Rate for Payer: PHCS Commercial |
$2,215.68
|
| Rate for Payer: United Healthcare All Payer |
$2,031.04
|
|
|
MAGSEED 18GM 7CM PART# 052617
|
Facility
|
IP
|
$2,308.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.04 |
| Max. Negotiated Rate |
$2,215.68 |
| Rate for Payer: Aetna Commercial |
$1,777.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,800.24
|
| Rate for Payer: Cash Price |
$1,154.00
|
| Rate for Payer: Cigna Commercial |
$1,915.64
|
| Rate for Payer: First Health Commercial |
$2,192.60
|
| Rate for Payer: Humana Commercial |
$1,961.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,892.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,703.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,031.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,731.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$461.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$715.48
|
| Rate for Payer: PHCS Commercial |
$2,215.68
|
| Rate for Payer: United Healthcare All Payer |
$2,031.04
|
|
|
MAG-TAB (MAGNESIUM L 84MG/1TAB
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 59016042019
|
| Hospital Charge Code |
25000941
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
MAG-TAB (MAGNESIUM L 84MG/1TAB
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 59016042019
|
| Hospital Charge Code |
25000941
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.34 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.75
|
| Rate for Payer: First Health Commercial |
$4.29
|
| Rate for Payer: Humana Commercial |
$3.84
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.98
|
| Rate for Payer: Ohio Health Group HMO |
$3.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Payer |
$3.98
|
|
|
MAHURKAR 12 X 16 TRIPLE LUMEN
|
Facility
|
OP
|
$3,281.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.53 |
| Max. Negotiated Rate |
$3,149.76 |
| Rate for Payer: Aetna Commercial |
$2,526.37
|
| Rate for Payer: Anthem Medicaid |
$1,128.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,559.18
|
| Rate for Payer: Cash Price |
$1,640.50
|
| Rate for Payer: Cigna Commercial |
$2,723.23
|
| Rate for Payer: First Health Commercial |
$3,116.95
|
| Rate for Payer: Humana Commercial |
$2,788.85
|
| Rate for Payer: Humana KY Medicaid |
$1,128.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,139.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,690.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,421.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$984.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,150.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,887.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,460.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.11
|
| Rate for Payer: PHCS Commercial |
$3,149.76
|
| Rate for Payer: United Healthcare All Payer |
$2,887.28
|
|
|
MAHURKAR 12 X 16 TRIPLE LUMEN
|
Facility
|
IP
|
$3,281.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.53 |
| Max. Negotiated Rate |
$3,149.76 |
| Rate for Payer: Aetna Commercial |
$2,526.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,559.18
|
| Rate for Payer: Cash Price |
$1,640.50
|
| Rate for Payer: Cigna Commercial |
$2,723.23
|
| Rate for Payer: First Health Commercial |
$3,116.95
|
| Rate for Payer: Humana Commercial |
$2,788.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,690.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,421.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$984.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,887.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,460.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.11
|
| Rate for Payer: PHCS Commercial |
$3,149.76
|
| Rate for Payer: United Healthcare All Payer |
$2,887.28
|
|
|
MAILMAN 182CM
|
Facility
|
IP
|
$1,123.91
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.11 |
| Max. Negotiated Rate |
$1,078.95 |
| Rate for Payer: Aetna Commercial |
$865.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$876.65
|
| Rate for Payer: Cash Price |
$561.96
|
| Rate for Payer: Cigna Commercial |
$932.85
|
| Rate for Payer: First Health Commercial |
$1,067.71
|
| Rate for Payer: Humana Commercial |
$955.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$921.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$829.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$989.04
|
| Rate for Payer: Ohio Health Group HMO |
$842.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.41
|
| Rate for Payer: PHCS Commercial |
$1,078.95
|
| Rate for Payer: United Healthcare All Payer |
$989.04
|
|
