|
MOD TP LCK(R) FEM PORS 11X142
|
Facility
|
OP
|
$22,334.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.50 |
| Max. Negotiated Rate |
$21,441.22 |
| Rate for Payer: PHCS Commercial |
$21,441.22
|
| Rate for Payer: Aetna Commercial |
$17,197.64
|
| Rate for Payer: Anthem Medicaid |
$7,680.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,420.99
|
| Rate for Payer: Cash Price |
$11,167.30
|
| Rate for Payer: Cigna Commercial |
$18,537.72
|
| Rate for Payer: First Health Commercial |
$21,217.87
|
| Rate for Payer: Humana Commercial |
$18,984.41
|
| Rate for Payer: Humana KY Medicaid |
$7,680.87
|
| Rate for Payer: Kentucky WC Medicaid |
$7,759.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,314.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,482.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,700.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,834.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,654.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,750.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,466.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,903.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,923.73
|
| Rate for Payer: United Healthcare All Payer |
$19,654.45
|
|
|
MOD TP LCK(R) FEM PORS 11X142
|
Facility
|
IP
|
$22,334.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.50 |
| Max. Negotiated Rate |
$21,441.22 |
| Rate for Payer: Aetna Commercial |
$17,197.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,420.99
|
| Rate for Payer: Cash Price |
$11,167.30
|
| Rate for Payer: Cigna Commercial |
$18,537.72
|
| Rate for Payer: First Health Commercial |
$21,217.87
|
| Rate for Payer: Humana Commercial |
$18,984.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,314.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,482.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,700.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,654.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,750.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,466.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,903.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,923.73
|
| Rate for Payer: PHCS Commercial |
$21,441.22
|
| Rate for Payer: United Healthcare All Payer |
$19,654.45
|
|
|
MODULAR HEAD SLEEVE +4MM
|
Facility
|
IP
|
$3,166.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.69 |
| Max. Negotiated Rate |
$3,040.20 |
| Rate for Payer: Aetna Commercial |
$2,438.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,470.17
|
| Rate for Payer: Cash Price |
$1,583.44
|
| Rate for Payer: Cigna Commercial |
$2,628.51
|
| Rate for Payer: First Health Commercial |
$3,008.54
|
| Rate for Payer: Humana Commercial |
$2,691.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,375.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.73
|
| Rate for Payer: PHCS Commercial |
$3,040.20
|
| Rate for Payer: United Healthcare All Payer |
$2,786.85
|
|
|
MODULAR HEAD SLEEVE +4MM
|
Facility
|
OP
|
$3,166.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.69 |
| Max. Negotiated Rate |
$3,040.20 |
| Rate for Payer: Aetna Commercial |
$2,438.50
|
| Rate for Payer: Anthem Medicaid |
$1,089.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,470.17
|
| Rate for Payer: Cash Price |
$1,583.44
|
| Rate for Payer: Cigna Commercial |
$2,628.51
|
| Rate for Payer: First Health Commercial |
$3,008.54
|
| Rate for Payer: Humana Commercial |
$2,691.85
|
| Rate for Payer: Humana KY Medicaid |
$1,089.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,100.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,375.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.73
|
| Rate for Payer: PHCS Commercial |
$3,040.20
|
| Rate for Payer: United Healthcare All Payer |
$2,786.85
|
|
|
MODULAR HEAD SLEEVE +8MM
|
Facility
|
IP
|
$3,166.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.69 |
| Max. Negotiated Rate |
$3,040.20 |
| Rate for Payer: Aetna Commercial |
$2,438.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,470.17
|
| Rate for Payer: Cash Price |
$1,583.44
|
| Rate for Payer: Cigna Commercial |
$2,628.51
|
| Rate for Payer: First Health Commercial |
$3,008.54
|
| Rate for Payer: Humana Commercial |
$2,691.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,375.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.73
|
| Rate for Payer: PHCS Commercial |
$3,040.20
|
| Rate for Payer: United Healthcare All Payer |
$2,786.85
|
|
|
MODULAR HEAD SLEEVE +8MM
|
Facility
|
OP
|
$3,166.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.69 |
| Max. Negotiated Rate |
$3,040.20 |
| Rate for Payer: Aetna Commercial |
$2,438.50
|
| Rate for Payer: Anthem Medicaid |
$1,089.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,470.17
|
| Rate for Payer: Cash Price |
$1,583.44
|
| Rate for Payer: Cigna Commercial |
$2,628.51
|
| Rate for Payer: First Health Commercial |
$3,008.54
|
| Rate for Payer: Humana Commercial |
$2,691.85
|
| Rate for Payer: Humana KY Medicaid |
$1,089.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,100.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,375.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.73
|
| Rate for Payer: PHCS Commercial |
$3,040.20
|
| Rate for Payer: United Healthcare All Payer |
$2,786.85
|
|
|
MODULAR II-C HUMERAL STEM
|
Facility
|
IP
|
$11,512.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$11,052.00 |
| Rate for Payer: Aetna Commercial |
$8,864.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,979.75
|
| Rate for Payer: Cash Price |
$5,756.25
|
| Rate for Payer: Cigna Commercial |
$9,555.38
|
| Rate for Payer: First Health Commercial |
$10,936.88
|
| Rate for Payer: Humana Commercial |
$9,785.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,440.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,496.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,131.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,568.88
|
| Rate for Payer: PHCS Commercial |
$11,052.00
|
| Rate for Payer: United Healthcare All Payer |
$10,131.00
|
|
|
MODULAR II-C HUMERAL STEM
|
Facility
|
OP
|
$11,512.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$11,052.00 |
| Rate for Payer: Aetna Commercial |
$8,864.62
|
| Rate for Payer: Anthem Medicaid |
$3,959.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,979.75
|
| Rate for Payer: Cash Price |
$5,756.25
|
| Rate for Payer: Cigna Commercial |
$9,555.38
|
| Rate for Payer: First Health Commercial |
$10,936.88
|
| Rate for Payer: Humana Commercial |
$9,785.62
|
| Rate for Payer: Humana KY Medicaid |
$3,959.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,999.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,440.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,496.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,038.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,131.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,568.88
|
| Rate for Payer: PHCS Commercial |
$11,052.00
|
| Rate for Payer: United Healthcare All Payer |
$10,131.00
|
|
|
MODURETIC (AMILOR./HCTZ) 1TAB
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
NDC 555048302
|
| Hospital Charge Code |
25001006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| 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 |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| 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 |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
MODURETIC (AMILOR./HCTZ) 1TAB
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
NDC 555048302
|
| Hospital Charge Code |
25001006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.48 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.64
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna Commercial |
$3.88
|
| Rate for Payer: First Health Commercial |
$4.44
|
| Rate for Payer: Humana Commercial |
$3.97
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.83
|
| 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 |
$4.11
|
| Rate for Payer: Ohio Health Group HMO |
$3.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| 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 |
$4.48
|
| Rate for Payer: United Healthcare All Payer |
$4.11
|
|
|
MOISTURIZE SKIN CREAM 118 mL
|
Facility
|
IP
|
$5.20
|
|
|
Service Code
|
NDC 53329015404
|
| Hospital Charge Code |
25004461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.06
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cigna Commercial |
$4.32
|
| Rate for Payer: First Health Commercial |
$4.94
|
| Rate for Payer: Humana Commercial |
$4.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.58
|
| Rate for Payer: Ohio Health Group HMO |
$3.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.61
|
| Rate for Payer: PHCS Commercial |
$4.99
|
| Rate for Payer: United Healthcare All Payer |
$4.58
|
|
|
MOISTURIZE SKIN CREAM 118 mL
|
Facility
|
OP
|
$5.20
|
|
|
Service Code
|
NDC 53329015404
|
| Hospital Charge Code |
25004461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Anthem Medicaid |
$1.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.06
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cigna Commercial |
$4.32
|
| Rate for Payer: First Health Commercial |
$4.94
|
| Rate for Payer: Humana Commercial |
$4.42
|
| Rate for Payer: Humana KY Medicaid |
$1.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.58
|
| Rate for Payer: Ohio Health Group HMO |
$3.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.61
|
| Rate for Payer: PHCS Commercial |
$4.99
|
| Rate for Payer: United Healthcare All Payer |
$4.58
|
|
|
MOISTURIZE SKIN CREAM 4 gm
|
Facility
|
OP
|
$9.26
|
|
|
Service Code
|
NDC 53329015404
|
| Hospital Charge Code |
25004462
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Aetna Commercial |
$7.13
|
| Rate for Payer: Anthem Medicaid |
$3.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.22
|
| Rate for Payer: Cash Price |
$4.63
|
| Rate for Payer: Cigna Commercial |
$7.69
|
| Rate for Payer: First Health Commercial |
$8.80
|
| Rate for Payer: Humana Commercial |
$7.87
|
| Rate for Payer: Humana KY Medicaid |
$3.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.15
|
| Rate for Payer: Ohio Health Group HMO |
$6.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.87
|
| Rate for Payer: PHCS Commercial |
$8.89
|
| Rate for Payer: United Healthcare All Payer |
$8.15
|
|
|
MOISTURIZE SKIN CREAM 4 gm
|
Facility
|
IP
|
$9.26
|
|
|
Service Code
|
NDC 53329015404
|
| Hospital Charge Code |
25004462
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Aetna Commercial |
$7.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.22
|
| Rate for Payer: Cash Price |
$4.63
|
| Rate for Payer: Cigna Commercial |
$7.69
|
| Rate for Payer: First Health Commercial |
$8.80
|
| Rate for Payer: Humana Commercial |
$7.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.15
|
| Rate for Payer: Ohio Health Group HMO |
$6.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.87
|
| Rate for Payer: PHCS Commercial |
$8.89
|
| Rate for Payer: United Healthcare All Payer |
$8.15
|
|
|
MOISTURIZE SKIN CREAM 59 mL
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
NDC 53329015413
|
| Hospital Charge Code |
25004454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$12.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.68
|
| Rate for Payer: Cash Price |
$8.13
|
| Rate for Payer: Cigna Commercial |
$13.50
|
| Rate for Payer: First Health Commercial |
$15.45
|
| Rate for Payer: Humana Commercial |
$13.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.31
|
| Rate for Payer: Ohio Health Group HMO |
$12.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.04
|
| Rate for Payer: PHCS Commercial |
$15.61
|
| Rate for Payer: United Healthcare All Payer |
$14.31
|
|
|
MOISTURIZE SKIN CREAM 59 mL
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
NDC 53329015413
|
| Hospital Charge Code |
25004454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$15.61 |
| Rate for Payer: Aetna Commercial |
$12.52
|
| Rate for Payer: Anthem Medicaid |
$5.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.68
|
| Rate for Payer: Cash Price |
$8.13
|
| Rate for Payer: Cigna Commercial |
$13.50
|
| Rate for Payer: First Health Commercial |
$15.45
|
| Rate for Payer: Humana Commercial |
$13.82
|
| Rate for Payer: Humana KY Medicaid |
$5.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.31
|
| Rate for Payer: Ohio Health Group HMO |
$12.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.04
|
| Rate for Payer: PHCS Commercial |
$15.61
|
| Rate for Payer: United Healthcare All Payer |
$14.31
|
|
|
MOLD DEFINITIVE IDENTIFICATION
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
30001278
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$10.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.32
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$10.32
|
| Rate for Payer: Humana Medicare Advantage |
$10.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
MOLD DEFINITIVE IDENTIFICATION
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
30001278
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
MONISTAT 7(MICONAZOL 100MG/1EA
|
Facility
|
OP
|
$9.17
|
|
|
Service Code
|
NDC 61269073607
|
| Hospital Charge Code |
25001007
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Anthem Medicaid |
$3.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.15
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.61
|
| Rate for Payer: First Health Commercial |
$8.71
|
| Rate for Payer: Humana Commercial |
$7.79
|
| Rate for Payer: Humana KY Medicaid |
$3.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.07
|
| Rate for Payer: Ohio Health Group HMO |
$6.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.84
|
| Rate for Payer: PHCS Commercial |
$8.80
|
| Rate for Payer: United Healthcare All Payer |
$8.07
|
|
|
MONISTAT 7(MICONAZOL 100MG/1EA
|
Facility
|
IP
|
$9.17
|
|
|
Service Code
|
NDC 61269073607
|
| Hospital Charge Code |
25001007
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.15
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.61
|
| Rate for Payer: First Health Commercial |
$8.71
|
| Rate for Payer: Humana Commercial |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.07
|
| Rate for Payer: Ohio Health Group HMO |
$6.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.84
|
| Rate for Payer: PHCS Commercial |
$8.80
|
| Rate for Payer: United Healthcare All Payer |
$8.07
|
|
|
MONISTAT 7(MICONAZOLE) CR 45GM
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 24385059029
|
| Hospital Charge Code |
25001008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna Commercial |
$0.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.46
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.49
|
| Rate for Payer: First Health Commercial |
$0.56
|
| Rate for Payer: Humana Commercial |
$0.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.52
|
| Rate for Payer: Ohio Health Group HMO |
$0.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.18
|
| Rate for Payer: PHCS Commercial |
$0.57
|
| Rate for Payer: United Healthcare All Payer |
$0.52
|
|
|
MONISTAT 7(MICONAZOLE) CR 45GM
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 24385059029
|
| Hospital Charge Code |
25001008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna Commercial |
$0.45
|
| Rate for Payer: Anthem Medicaid |
$0.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.46
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.49
|
| Rate for Payer: First Health Commercial |
$0.56
|
| Rate for Payer: Humana Commercial |
$0.50
|
| Rate for Payer: Humana KY Medicaid |
$0.20
|
| Rate for Payer: Kentucky WC Medicaid |
$0.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.52
|
| Rate for Payer: Ohio Health Group HMO |
$0.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.18
|
| Rate for Payer: PHCS Commercial |
$0.57
|
| Rate for Payer: United Healthcare All Payer |
$0.52
|
|
|
MONISTAT DERM (MICONAZOLE 15GM
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 51672200101
|
| Hospital Charge Code |
25001009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna Commercial |
$0.17
|
| Rate for Payer: Anthem Medicaid |
$0.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.17
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna Commercial |
$0.18
|
| Rate for Payer: First Health Commercial |
$0.21
|
| Rate for Payer: Humana Commercial |
$0.19
|
| Rate for Payer: Humana KY Medicaid |
$0.08
|
| Rate for Payer: Kentucky WC Medicaid |
$0.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.19
|
| Rate for Payer: Ohio Health Group HMO |
$0.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.07
|
| Rate for Payer: PHCS Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Payer |
$0.19
|
|
|
MONISTAT DERM (MICONAZOLE 15GM
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 51672200101
|
| Hospital Charge Code |
25001009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna Commercial |
$0.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.17
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna Commercial |
$0.18
|
| Rate for Payer: First Health Commercial |
$0.21
|
| Rate for Payer: Humana Commercial |
$0.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.19
|
| Rate for Payer: Ohio Health Group HMO |
$0.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.07
|
| Rate for Payer: PHCS Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Payer |
$0.19
|
|
|
MONOFERRIC 10mg (1,000mg)
|
Facility
|
OP
|
$18,402.69
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
25004131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.86 |
| Max. Negotiated Rate |
$17,666.58 |
| Rate for Payer: Aetna Commercial |
$14,170.07
|
| Rate for Payer: Anthem Medicaid |
$6,328.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,354.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.47
|
| Rate for Payer: Cash Price |
$9,201.34
|
| Rate for Payer: Cash Price |
$9,201.34
|
| Rate for Payer: Cigna Commercial |
$15,274.23
|
| Rate for Payer: First Health Commercial |
$17,482.56
|
| Rate for Payer: Humana Commercial |
$15,642.29
|
| Rate for Payer: Humana KY Medicaid |
$6,328.69
|
| Rate for Payer: Humana Medicare Advantage |
$18.86
|
| Rate for Payer: Kentucky WC Medicaid |
$6,393.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,090.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,581.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,455.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,194.37
|
| Rate for Payer: Ohio Health Group HMO |
$13,802.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,680.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,392.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,704.83
|
| Rate for Payer: PHCS Commercial |
$17,666.58
|
| Rate for Payer: United Healthcare All Payer |
$16,194.37
|
|
