|
MEGACE (MEGESTROL) 4 40MG/1TAB
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 555060702
|
| Hospital Charge Code |
25000954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| 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 |
$2.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.64
|
| 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 |
$7.80 |
| 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 |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| 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 |
$7.80 |
| 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 |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| 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 |
$0.59 |
| 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 |
$1.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| 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 |
$0.59 |
| 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 |
$1.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$1.88
|
| Rate for Payer: United Healthcare All Payer |
$1.72
|
|
|
MEIER GUIDEWIRE 0.35 260CM
|
Facility
|
IP
|
$1,894.55
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.37 |
| Max. Negotiated Rate |
$1,818.77 |
| Rate for Payer: Aetna Commercial |
$1,458.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,477.75
|
| Rate for Payer: Cash Price |
$947.27
|
| Rate for Payer: Cigna Commercial |
$1,572.48
|
| Rate for Payer: First Health Commercial |
$1,799.82
|
| Rate for Payer: Humana Commercial |
$1,610.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,553.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,398.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,667.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,420.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,515.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,648.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.24
|
| Rate for Payer: PHCS Commercial |
$1,818.77
|
| Rate for Payer: United Healthcare All Payer |
$1,667.20
|
|
|
MEIER GUIDEWIRE 0.35 260CM
|
Facility
|
OP
|
$1,894.55
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.37 |
| Max. Negotiated Rate |
$1,818.77 |
| Rate for Payer: Aetna Commercial |
$1,458.80
|
| Rate for Payer: Anthem Medicaid |
$651.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,477.75
|
| Rate for Payer: Cash Price |
$947.27
|
| Rate for Payer: Cigna Commercial |
$1,572.48
|
| Rate for Payer: First Health Commercial |
$1,799.82
|
| Rate for Payer: Humana Commercial |
$1,610.37
|
| Rate for Payer: Humana KY Medicaid |
$651.54
|
| Rate for Payer: Kentucky WC Medicaid |
$658.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,553.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,398.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$664.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,667.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,420.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,515.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,648.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.24
|
| Rate for Payer: PHCS Commercial |
$1,818.77
|
| Rate for Payer: United Healthcare All Payer |
$1,667.20
|
|
|
MELAMIN 80 ML
|
Professional
|
Both
|
$66.00
|
|
| Hospital Charge Code |
22200155
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$46.20 |
| 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 80 ML
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
22200155
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$22.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.48
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Humana KY Medicaid |
$22.70
|
| Rate for Payer: Kentucky WC Medicaid |
$22.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
MELAMIN 80 ML
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
22200155
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.48
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
MELAMIN-C 85 G ZOMD
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
22200156
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.25
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
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 |
$87.50 |
| 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
|
|
|
MELAMIN-C 85 G ZOMD
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
22200156
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem Medicaid |
$42.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Humana KY Medicaid |
$42.99
|
| Rate for Payer: Kentucky WC Medicaid |
$43.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.25
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
MELAMIX 80 ML
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
22200157
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem Medicaid |
$22.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.92
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Humana KY Medicaid |
$22.01
|
| Rate for Payer: Kentucky WC Medicaid |
$22.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
MELAMIX 80 ML
|
Professional
|
Both
|
$64.00
|
|
| Hospital Charge Code |
22200157
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$44.80 |
| 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
|
|
|
MELAMIX 80 ML
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
22200157
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.92
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.16
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
MELATONIN 3MG TABLET
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 20555003601
|
| Hospital Charge Code |
25000956
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| 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 |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| 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 |
$1.30 |
| 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 |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
MELATONIN 5MG TAB
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 50428026927
|
| Hospital Charge Code |
25004556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
MELATONIN 5MG TAB
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 50428026927
|
| Hospital Charge Code |
25004556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
MELLARIL 50MG EQUIVALENT TAB
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 378061601
|
| Hospital Charge Code |
25003208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| 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 |
$4.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| 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 |
$1.51 |
| 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 |
$4.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.48
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
MELLARIL (THIORIDAZI 10MG/1TAB
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 378061201
|
| Hospital Charge Code |
25000957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| 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 |
$3.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.23
|
| Rate for Payer: PHCS Commercial |
$4.49
|
| Rate for Payer: United Healthcare All Payer |
$4.12
|
|
|
MELLARIL (THIORIDAZI 10MG/1TAB
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 378061201
|
| Hospital Charge Code |
25000957
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| 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 |
$3.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.23
|
| 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
|
$9,391.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,817.34 |
| Max. Negotiated Rate |
$9,015.50 |
| Rate for Payer: Aetna Commercial |
$7,231.19
|
| Rate for Payer: Anthem Medicaid |
$3,229.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,325.10
|
| Rate for Payer: Cash Price |
$4,695.58
|
| Rate for Payer: Cigna Commercial |
$7,794.65
|
| Rate for Payer: First Health Commercial |
$8,921.59
|
| Rate for Payer: Humana Commercial |
$7,982.48
|
| Rate for Payer: Humana KY Medicaid |
$3,229.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,262.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,700.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,930.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,817.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,294.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,264.21
|
| Rate for Payer: Ohio Health Group HMO |
$7,043.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,512.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,170.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,479.89
|
| Rate for Payer: PHCS Commercial |
$9,015.50
|
| Rate for Payer: United Healthcare All Payer |
$8,264.21
|
|
