|
MINERAL OIL 30 ML 30ML
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 46122039516
|
| Hospital Charge Code |
25000986
|
|
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
|
|
|
MINERAL OIL 30 ML 30ML
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 46122039516
|
| Hospital Charge Code |
25000986
|
|
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
|
|
|
MINERAL OIL LIGHT STERILE 10ML
|
Facility
|
OP
|
$36.98
|
|
|
Service Code
|
NDC 63323025410
|
| Hospital Charge Code |
25000987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Anthem Medicaid |
$12.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.84
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: Cigna Commercial |
$30.69
|
| Rate for Payer: First Health Commercial |
$35.13
|
| Rate for Payer: Humana Commercial |
$31.43
|
| Rate for Payer: Humana KY Medicaid |
$12.72
|
| Rate for Payer: Kentucky WC Medicaid |
$12.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.54
|
| Rate for Payer: Ohio Health Group HMO |
$27.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.46
|
| Rate for Payer: PHCS Commercial |
$35.50
|
| Rate for Payer: United Healthcare All Payer |
$32.54
|
| Rate for Payer: Aetna Commercial |
$28.47
|
|
|
MINERAL OIL LIGHT STERILE 10ML
|
Facility
|
IP
|
$36.98
|
|
|
Service Code
|
NDC 63323025410
|
| Hospital Charge Code |
25000987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Aetna Commercial |
$28.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.84
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: Cigna Commercial |
$30.69
|
| Rate for Payer: First Health Commercial |
$35.13
|
| Rate for Payer: Humana Commercial |
$31.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.54
|
| Rate for Payer: Ohio Health Group HMO |
$27.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.46
|
| Rate for Payer: PHCS Commercial |
$35.50
|
| Rate for Payer: United Healthcare All Payer |
$32.54
|
|
|
MINERIN CR��ME APPL 454GM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 904775127
|
| Hospital Charge Code |
25003850
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: Humana Commercial |
$0.01
|
| Rate for Payer: Humana KY Medicaid |
$0.00
|
| Rate for Payer: Kentucky WC Medicaid |
$0.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.01
|
| Rate for Payer: Ohio Health Group HMO |
$0.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.00
|
| Rate for Payer: PHCS Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Payer |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Anthem Medicaid |
$0.00
|
|
|
MINERIN CR��ME APPL 454GM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
NDC 904775127
|
| Hospital Charge Code |
25003850
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: First Health Commercial |
$0.01
|
| Rate for Payer: Humana Commercial |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.01
|
| Rate for Payer: Ohio Health Group HMO |
$0.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.00
|
| Rate for Payer: PHCS Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Payer |
$0.01
|
|
|
MINI-INCISION SYSTEM
|
Facility
|
OP
|
$26,681.75
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,468.63 |
| Max. Negotiated Rate |
$25,614.48 |
| Rate for Payer: Aetna Commercial |
$20,544.95
|
| Rate for Payer: Anthem Medicaid |
$9,175.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,811.76
|
| Rate for Payer: Cash Price |
$13,340.88
|
| Rate for Payer: Cigna Commercial |
$22,145.85
|
| Rate for Payer: First Health Commercial |
$25,347.66
|
| Rate for Payer: Humana Commercial |
$22,679.49
|
| Rate for Payer: Humana KY Medicaid |
$9,175.85
|
| Rate for Payer: Kentucky WC Medicaid |
$9,269.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,879.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,691.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,004.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,359.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,479.94
|
| Rate for Payer: Ohio Health Group HMO |
$20,011.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,468.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,271.34
|
| Rate for Payer: PHCS Commercial |
$25,614.48
|
| Rate for Payer: United Healthcare All Payer |
$23,479.94
|
|
|
MINI-INCISION SYSTEM
|
Facility
|
IP
|
$26,681.75
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,468.63 |
| Max. Negotiated Rate |
$25,614.48 |
| Rate for Payer: Aetna Commercial |
$20,544.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,811.76
|
| Rate for Payer: Cash Price |
$13,340.88
|
| Rate for Payer: Cigna Commercial |
$22,145.85
|
| Rate for Payer: First Health Commercial |
$25,347.66
|
| Rate for Payer: Humana Commercial |
$22,679.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,879.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,691.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,004.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,479.94
|
| Rate for Payer: Ohio Health Group HMO |
$20,011.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,468.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,271.34
|
| Rate for Payer: PHCS Commercial |
$25,614.48
|
| Rate for Payer: United Healthcare All Payer |
$23,479.94
|
|
|
MINI LAPAROTOMY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58600
|
| Hospital Charge Code |
76102244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
MINI LAPAROTOMY
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58600
|
| Hospital Charge Code |
76102244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
MINI LAPAROTOMY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58600
|
| Hospital Charge Code |
76102244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$547.99
|
| Rate for Payer: Anthem Medicaid |
$271.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$540.38
|
| Rate for Payer: Healthspan PPO |
$530.60
|
| Rate for Payer: Humana Medicaid |
$271.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$472.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.18
|
| Rate for Payer: Molina Healthcare Passport |
$271.75
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.47
|
|
|
MINI LAPAROTOMY(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58600
|
| Hospital Charge Code |
761P2244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$547.99
|
| Rate for Payer: Anthem Medicaid |
$271.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$540.38
|
| Rate for Payer: Healthspan PPO |
$530.60
|
| Rate for Payer: Humana Medicaid |
$271.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$472.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.18
|
| Rate for Payer: Molina Healthcare Passport |
$271.75
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.47
|
|
|
MINI MIIG X3 INJ GRAFT 5CC
|
Facility
|
IP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
MINI MIIG X3 INJ GRAFT 5CC
|
Facility
|
OP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem Medicaid |
$3,708.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Humana KY Medicaid |
$3,708.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,745.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,782.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
MINIPRESS (PRAZOSIN) 1MG/1CAP
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 70954001910
|
| Hospital Charge Code |
25000988
|
|
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
|
|
|
MINIPRESS (PRAZOSIN) 1MG/1CAP
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 70954001910
|
| Hospital Charge Code |
25000988
|
|
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
|
|
|
MINIPRESS (PRAZOSIN) 2MG/1CAP
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
NDC 70954002010
|
| Hospital Charge Code |
25000989
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
MINIPRESS (PRAZOSIN) 2MG/1CAP
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 70954002010
|
| Hospital Charge Code |
25000989
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
|
MINIPRESS (PRAZOSIN) 5MG/1CAP
|
Facility
|
OP
|
$11.43
|
|
|
Service Code
|
NDC 60687057232
|
| Hospital Charge Code |
25000990
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$10.97 |
| Rate for Payer: Aetna Commercial |
$8.80
|
| Rate for Payer: Anthem Medicaid |
$3.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.92
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cigna Commercial |
$9.49
|
| Rate for Payer: First Health Commercial |
$10.86
|
| Rate for Payer: Humana Commercial |
$9.72
|
| Rate for Payer: Humana KY Medicaid |
$3.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.06
|
| Rate for Payer: Ohio Health Group HMO |
$8.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.54
|
| Rate for Payer: PHCS Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Payer |
$10.06
|
|
|
MINIPRESS (PRAZOSIN) 5MG/1CAP
|
Facility
|
IP
|
$11.43
|
|
|
Service Code
|
NDC 60687057232
|
| Hospital Charge Code |
25000990
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$10.97 |
| Rate for Payer: Aetna Commercial |
$8.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.92
|
| Rate for Payer: Cash Price |
$5.72
|
| Rate for Payer: Cigna Commercial |
$9.49
|
| Rate for Payer: First Health Commercial |
$10.86
|
| Rate for Payer: Humana Commercial |
$9.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.06
|
| Rate for Payer: Ohio Health Group HMO |
$8.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.54
|
| Rate for Payer: PHCS Commercial |
$10.97
|
| Rate for Payer: United Healthcare All Payer |
$10.06
|
|
|
MINI TREK DILATION CATH 1.20*8
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
MINI TREK DILATION CATH 1.20*8
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
|
|
MINI TREK DILATN CATH 1.20*12M
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
MINI TREK DILATN CATH 1.20*12M
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
MINI TREK II OTW 1.2*12
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
