|
MEFOXIN (CEFOXITIN) 1G 1GM/5ML
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
25001938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
MEFOXIN (CEFOXITIN) 1G 1GM/5ML
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
25001938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$38.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$38.86
|
| Rate for Payer: Kentucky WC Medicaid |
$39.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
MEFOXIN (CEFOXITIN) 2GRAM SYR
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
25001940
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$40.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$40.24
|
| Rate for Payer: Kentucky WC Medicaid |
$40.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
MEFOXIN (CEFOXITIN) 2GRAM SYR
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
25001940
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
MEGA 30CC IAB
|
Facility
|
OP
|
$5,233.84
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$680.40 |
| Max. Negotiated Rate |
$5,024.49 |
| Rate for Payer: Aetna Commercial |
$4,030.06
|
| Rate for Payer: Anthem Medicaid |
$1,799.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,082.40
|
| Rate for Payer: Cash Price |
$2,616.92
|
| Rate for Payer: Cigna Commercial |
$4,344.09
|
| Rate for Payer: First Health Commercial |
$4,972.15
|
| Rate for Payer: Humana Commercial |
$4,448.76
|
| Rate for Payer: Humana KY Medicaid |
$1,799.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,818.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,291.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,862.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,570.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,836.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,605.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,925.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,046.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$680.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,622.49
|
| Rate for Payer: PHCS Commercial |
$5,024.49
|
| Rate for Payer: United Healthcare All Payer |
$4,605.78
|
|
|
MEGA 30CC IAB
|
Facility
|
IP
|
$5,233.84
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$680.40 |
| Max. Negotiated Rate |
$5,024.49 |
| Rate for Payer: Aetna Commercial |
$4,030.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,082.40
|
| Rate for Payer: Cash Price |
$2,616.92
|
| Rate for Payer: Cigna Commercial |
$4,344.09
|
| Rate for Payer: First Health Commercial |
$4,972.15
|
| Rate for Payer: Humana Commercial |
$4,448.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,291.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,862.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,570.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,605.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,925.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,046.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$680.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,622.49
|
| Rate for Payer: PHCS Commercial |
$5,024.49
|
| Rate for Payer: United Healthcare All Payer |
$4,605.78
|
|
|
MEGACE (MEGESTROL) 4 40MG/1TAB
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 555060702
|
| Hospital Charge Code |
25000954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Anthem Medicaid |
$1.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.98
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cigna Commercial |
$3.17
|
| Rate for Payer: First Health Commercial |
$3.63
|
| Rate for Payer: Humana Commercial |
$3.25
|
| Rate for Payer: Humana KY Medicaid |
$1.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.36
|
| Rate for Payer: Ohio Health Group HMO |
$2.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.18
|
| Rate for Payer: PHCS Commercial |
$3.67
|
| Rate for Payer: United Healthcare All Payer |
$3.36
|
|
|
MEGACE (MEGESTROL) 4 40MG/1TAB
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 555060702
|
| Hospital Charge Code |
25000954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.98
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Cigna Commercial |
$3.17
|
| Rate for Payer: First Health Commercial |
$3.63
|
| Rate for Payer: Humana Commercial |
$3.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.36
|
| Rate for Payer: Ohio Health Group HMO |
$2.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.18
|
| Rate for Payer: PHCS Commercial |
$3.67
|
| Rate for Payer: United Healthcare All Payer |
$3.36
|
|
|
MEGACE ORAL 40MG/ML
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
NDC 68094006362
|
| Hospital Charge Code |
25000955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.28
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$8.94
|
| Rate for Payer: Kentucky WC Medicaid |
$9.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
MEGACE ORAL 40MG/ML
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
NDC 68094006362
|
| Hospital Charge Code |
25000955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.28
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
MEGESTROL ACETATE 20MG TABLET
|
Facility
|
IP
|
$1.96
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
25004244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.53
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna Commercial |
$1.63
|
| Rate for Payer: First Health Commercial |
$1.86
|
| Rate for Payer: Humana Commercial |
$1.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.72
|
| Rate for Payer: Ohio Health Group HMO |
$1.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.61
|
| Rate for Payer: PHCS Commercial |
$1.88
|
| Rate for Payer: United Healthcare All Payer |
$1.72
|
|
|
MEGESTROL ACETATE 20MG TABLET
|
Facility
|
OP
|
$1.96
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
25004244
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.51
|
| Rate for Payer: Anthem Medicaid |
$0.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.53
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Cigna Commercial |
$1.63
|
| Rate for Payer: First Health Commercial |
$1.86
|
| Rate for Payer: Humana Commercial |
$1.67
|
| Rate for Payer: Humana KY Medicaid |
$0.67
|
| Rate for Payer: Kentucky WC Medicaid |
$0.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.72
|
| Rate for Payer: Ohio Health Group HMO |
$1.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.61
|
| Rate for Payer: PHCS Commercial |
$1.88
|
| Rate for Payer: United Healthcare All Payer |
$1.72
|
|
|
MEIER GUIDEWIRE 0.35 260CM
|
Facility
|
OP
|
$1,897.61
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.69 |
| Max. Negotiated Rate |
$1,821.71 |
| Rate for Payer: Aetna Commercial |
$1,461.16
|
| Rate for Payer: Anthem Medicaid |
$652.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,480.14
|
| Rate for Payer: Cash Price |
$948.80
|
| Rate for Payer: Cigna Commercial |
$1,575.02
|
| Rate for Payer: First Health Commercial |
$1,802.73
|
| Rate for Payer: Humana Commercial |
$1,612.97
|
| Rate for Payer: Humana KY Medicaid |
$652.59
|
| Rate for Payer: Kentucky WC Medicaid |
$659.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,556.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,400.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,669.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,423.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.26
|
| Rate for Payer: PHCS Commercial |
$1,821.71
|
| Rate for Payer: United Healthcare All Payer |
$1,669.90
|
|
|
MEIER GUIDEWIRE 0.35 260CM
|
Facility
|
IP
|
$1,897.61
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.69 |
| Max. Negotiated Rate |
$1,821.71 |
| Rate for Payer: Aetna Commercial |
$1,461.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,480.14
|
| Rate for Payer: Cash Price |
$948.80
|
| Rate for Payer: Cigna Commercial |
$1,575.02
|
| Rate for Payer: First Health Commercial |
$1,802.73
|
| Rate for Payer: Humana Commercial |
$1,612.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,556.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,400.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,669.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,423.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$588.26
|
| Rate for Payer: PHCS Commercial |
$1,821.71
|
| Rate for Payer: United Healthcare All Payer |
$1,669.90
|
|
|
MELAMIN 80 ML
|
Professional
|
Both
|
$66.00
|
|
| Hospital Charge Code |
22200155
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$66.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Multiplan PHCS |
$39.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.20
|
| Rate for Payer: UHCCP Medicaid |
$23.10
|
|
|
MELAMIN-C 85 G ZOMD
|
Professional
|
Both
|
$125.00
|
|
| Hospital Charge Code |
22200156
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
|
|
MELAMIX 80 ML
|
Professional
|
Both
|
$64.00
|
|
| Hospital Charge Code |
22200157
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$64.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Multiplan PHCS |
$38.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.80
|
| Rate for Payer: UHCCP Medicaid |
$22.40
|
|
|
MELATONIN 3MG TABLET
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 20555003601
|
| Hospital Charge Code |
25000956
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
MELATONIN 3MG TABLET
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 20555003601
|
| Hospital Charge Code |
25000956
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
MELLARIL 50MG EQUIVALENT TAB
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 378061601
|
| Hospital Charge Code |
25003208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
MELLARIL 50MG EQUIVALENT TAB
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 378061601
|
| Hospital Charge Code |
25003208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
MELLARIL (THIORIDAZI 10MG/1TAB
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 378061201
|
| Hospital Charge Code |
25000957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.45
|
| Rate for Payer: Humana Commercial |
$3.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.12
|
| Rate for Payer: Ohio Health Group HMO |
$3.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.49
|
| Rate for Payer: United Healthcare All Payer |
$4.12
|
|
|
MELLARIL (THIORIDAZI 10MG/1TAB
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 378061201
|
| Hospital Charge Code |
25000957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.45
|
| Rate for Payer: Humana Commercial |
$3.98
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.12
|
| Rate for Payer: Ohio Health Group HMO |
$3.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.49
|
| Rate for Payer: United Healthcare All Payer |
$4.12
|
|
|
MEMO 3D SEMI RGD ANNUL RING 24
|
Facility
|
OP
|
$9,191.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.85 |
| Max. Negotiated Rate |
$8,823.50 |
| Rate for Payer: Aetna Commercial |
$7,077.19
|
| Rate for Payer: Anthem Medicaid |
$3,160.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,169.10
|
| Rate for Payer: Cash Price |
$4,595.58
|
| Rate for Payer: Cigna Commercial |
$7,628.65
|
| Rate for Payer: First Health Commercial |
$8,731.59
|
| Rate for Payer: Humana Commercial |
$7,812.48
|
| Rate for Payer: Humana KY Medicaid |
$3,160.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,193.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,536.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,783.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,757.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,224.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,088.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,893.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,838.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,849.26
|
| Rate for Payer: PHCS Commercial |
$8,823.50
|
| Rate for Payer: United Healthcare All Payer |
$8,088.21
|
|
|
MEMO 3D SEMI RGD ANNUL RING 24
|
Facility
|
IP
|
$9,191.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.85 |
| Max. Negotiated Rate |
$8,823.50 |
| Rate for Payer: Aetna Commercial |
$7,077.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,169.10
|
| Rate for Payer: Cash Price |
$4,595.58
|
| Rate for Payer: Cigna Commercial |
$7,628.65
|
| Rate for Payer: First Health Commercial |
$8,731.59
|
| Rate for Payer: Humana Commercial |
$7,812.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,536.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,783.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,757.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,088.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,893.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,838.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,849.26
|
| Rate for Payer: PHCS Commercial |
$8,823.50
|
| Rate for Payer: United Healthcare All Payer |
$8,088.21
|
|
