|
MORPHINE 10mg PF Cartridge
|
Facility
|
IP
|
$77.31
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25004414
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$74.22 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.30
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cigna Commercial |
$64.17
|
| Rate for Payer: First Health Commercial |
$73.44
|
| Rate for Payer: Humana Commercial |
$65.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.03
|
| Rate for Payer: Ohio Health Group HMO |
$57.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.97
|
| Rate for Payer: PHCS Commercial |
$74.22
|
| Rate for Payer: United Healthcare All Payer |
$68.03
|
|
|
MORPHINE 10MGVPF(DURMRPH)10MG
|
Facility
|
IP
|
$103.96
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
25002254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$99.80 |
| Rate for Payer: Aetna Commercial |
$80.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.09
|
| Rate for Payer: Cash Price |
$51.98
|
| Rate for Payer: Cigna Commercial |
$86.29
|
| Rate for Payer: First Health Commercial |
$98.76
|
| Rate for Payer: Humana Commercial |
$88.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.48
|
| Rate for Payer: Ohio Health Group HMO |
$77.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.23
|
| Rate for Payer: PHCS Commercial |
$99.80
|
| Rate for Payer: United Healthcare All Payer |
$91.48
|
|
|
MORPHINE 10MGVPF(DURMRPH)10MG
|
Facility
|
OP
|
$103.96
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
25002254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$99.80 |
| Rate for Payer: Aetna Commercial |
$80.05
|
| Rate for Payer: Anthem Medicaid |
$35.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.09
|
| Rate for Payer: Cash Price |
$51.98
|
| Rate for Payer: Cigna Commercial |
$86.29
|
| Rate for Payer: First Health Commercial |
$98.76
|
| Rate for Payer: Humana Commercial |
$88.37
|
| Rate for Payer: Humana KY Medicaid |
$35.75
|
| Rate for Payer: Kentucky WC Medicaid |
$36.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.48
|
| Rate for Payer: Ohio Health Group HMO |
$77.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.23
|
| Rate for Payer: PHCS Commercial |
$99.80
|
| Rate for Payer: United Healthcare All Payer |
$91.48
|
|
|
MORPHINE 8 MG PF CARTRIDGE
|
Facility
|
IP
|
$77.31
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25004415
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$74.22 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.30
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cigna Commercial |
$64.17
|
| Rate for Payer: First Health Commercial |
$73.44
|
| Rate for Payer: Humana Commercial |
$65.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.03
|
| Rate for Payer: Ohio Health Group HMO |
$57.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.97
|
| Rate for Payer: PHCS Commercial |
$74.22
|
| Rate for Payer: United Healthcare All Payer |
$68.03
|
|
|
MORPHINE 8 MG PF CARTRIDGE
|
Facility
|
OP
|
$77.31
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25004415
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$74.22 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: Anthem Medicaid |
$26.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.30
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cigna Commercial |
$64.17
|
| Rate for Payer: First Health Commercial |
$73.44
|
| Rate for Payer: Humana Commercial |
$65.71
|
| Rate for Payer: Humana KY Medicaid |
$26.59
|
| Rate for Payer: Kentucky WC Medicaid |
$26.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.03
|
| Rate for Payer: Ohio Health Group HMO |
$57.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.97
|
| Rate for Payer: PHCS Commercial |
$74.22
|
| Rate for Payer: United Healthcare All Payer |
$68.03
|
|
|
MORPHINE INJ UP TO 10 MG
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
636T0043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$29.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.30
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$29.23
|
| Rate for Payer: Kentucky WC Medicaid |
$29.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.35
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
MORPHINE INJ UP TO 10 MG
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
63600043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.30
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.35
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
MORPHINE INJ UP TO 10 MG
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
636T0043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.30
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.35
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
MORPHINE INJ UP TO 10 MG
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
63600043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$4.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.00
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Healthspan PPO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.25
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
|
|
MORPHINE INJ UP TO 10 MG
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
63600043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$29.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.30
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$29.23
|
| Rate for Payer: Kentucky WC Medicaid |
$29.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.35
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
MORPHINE (IR) 30 MG TABLET
|
Facility
|
IP
|
$60.74
|
|
|
Service Code
|
NDC 54023625
|
| Hospital Charge Code |
25003220
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$58.31 |
| Rate for Payer: Aetna Commercial |
$46.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.38
|
| Rate for Payer: Cash Price |
$30.37
|
| Rate for Payer: Cigna Commercial |
$50.41
|
| Rate for Payer: First Health Commercial |
$57.70
|
| Rate for Payer: Humana Commercial |
$51.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.45
|
| Rate for Payer: Ohio Health Group HMO |
$45.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.83
|
| Rate for Payer: PHCS Commercial |
$58.31
|
| Rate for Payer: United Healthcare All Payer |
$53.45
|
|
|
MORPHINE (IR) 30 MG TABLET
|
Facility
|
OP
|
$60.74
|
|
|
Service Code
|
NDC 54023625
|
| Hospital Charge Code |
25003220
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$58.31 |
| Rate for Payer: Aetna Commercial |
$46.77
|
| Rate for Payer: Anthem Medicaid |
$20.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.38
|
| Rate for Payer: Cash Price |
$30.37
|
| Rate for Payer: Cigna Commercial |
$50.41
|
| Rate for Payer: First Health Commercial |
$57.70
|
| Rate for Payer: Humana Commercial |
$51.63
|
| Rate for Payer: Humana KY Medicaid |
$20.89
|
| Rate for Payer: Kentucky WC Medicaid |
$21.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.45
|
| Rate for Payer: Ohio Health Group HMO |
$45.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.83
|
| Rate for Payer: PHCS Commercial |
$58.31
|
| Rate for Payer: United Healthcare All Payer |
$53.45
|
|
|
MORPHINE R T 10MG 3ML
|
Facility
|
OP
|
$61.25
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003224
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$58.80 |
| Rate for Payer: Aetna Commercial |
$47.16
|
| Rate for Payer: Anthem Medicaid |
$21.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.78
|
| Rate for Payer: Cash Price |
$30.62
|
| Rate for Payer: Cigna Commercial |
$50.84
|
| Rate for Payer: First Health Commercial |
$58.19
|
| Rate for Payer: Humana Commercial |
$52.06
|
| Rate for Payer: Humana KY Medicaid |
$21.06
|
| Rate for Payer: Kentucky WC Medicaid |
$21.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.90
|
| Rate for Payer: Ohio Health Group HMO |
$45.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.99
|
| Rate for Payer: PHCS Commercial |
$58.80
|
| Rate for Payer: United Healthcare All Payer |
$53.90
|
|
|
MORPHINE R T 10MG 3ML
|
Facility
|
IP
|
$61.25
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003224
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$58.80 |
| Rate for Payer: Aetna Commercial |
$47.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.78
|
| Rate for Payer: Cash Price |
$30.62
|
| Rate for Payer: Cigna Commercial |
$50.84
|
| Rate for Payer: First Health Commercial |
$58.19
|
| Rate for Payer: Humana Commercial |
$52.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.90
|
| Rate for Payer: Ohio Health Group HMO |
$45.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.99
|
| Rate for Payer: PHCS Commercial |
$58.80
|
| Rate for Payer: United Healthcare All Payer |
$53.90
|
|
|
MORPHINE R T 15MG 3ML
|
Facility
|
OP
|
$61.35
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$47.24
|
| Rate for Payer: Anthem Medicaid |
$21.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.85
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna Commercial |
$50.92
|
| Rate for Payer: First Health Commercial |
$58.28
|
| Rate for Payer: Humana Commercial |
$52.15
|
| Rate for Payer: Humana KY Medicaid |
$21.10
|
| Rate for Payer: Kentucky WC Medicaid |
$21.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.99
|
| Rate for Payer: Ohio Health Group HMO |
$46.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.02
|
| Rate for Payer: PHCS Commercial |
$58.90
|
| Rate for Payer: United Healthcare All Payer |
$53.99
|
|
|
MORPHINE R T 15MG 3ML
|
Facility
|
IP
|
$61.35
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$47.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.85
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna Commercial |
$50.92
|
| Rate for Payer: First Health Commercial |
$58.28
|
| Rate for Payer: Humana Commercial |
$52.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.99
|
| Rate for Payer: Ohio Health Group HMO |
$46.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.02
|
| Rate for Payer: PHCS Commercial |
$58.90
|
| Rate for Payer: United Healthcare All Payer |
$53.99
|
|
|
MORPHINE R T 20MG 3ML
|
Facility
|
IP
|
$61.44
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$58.98 |
| Rate for Payer: Aetna Commercial |
$47.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.92
|
| Rate for Payer: Cash Price |
$30.72
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: First Health Commercial |
$58.37
|
| Rate for Payer: Humana Commercial |
$52.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.07
|
| Rate for Payer: Ohio Health Group HMO |
$46.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.05
|
| Rate for Payer: PHCS Commercial |
$58.98
|
| Rate for Payer: United Healthcare All Payer |
$54.07
|
|
|
MORPHINE R T 20MG 3ML
|
Facility
|
OP
|
$61.44
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$58.98 |
| Rate for Payer: Aetna Commercial |
$47.31
|
| Rate for Payer: Anthem Medicaid |
$21.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.92
|
| Rate for Payer: Cash Price |
$30.72
|
| Rate for Payer: Cigna Commercial |
$51.00
|
| Rate for Payer: First Health Commercial |
$58.37
|
| Rate for Payer: Humana Commercial |
$52.22
|
| Rate for Payer: Humana KY Medicaid |
$21.13
|
| Rate for Payer: Kentucky WC Medicaid |
$21.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.07
|
| Rate for Payer: Ohio Health Group HMO |
$46.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.05
|
| Rate for Payer: PHCS Commercial |
$58.98
|
| Rate for Payer: United Healthcare All Payer |
$54.07
|
|
|
MORPHINE R T 5MG 3ML
|
Facility
|
OP
|
$61.16
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003227
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$58.71 |
| Rate for Payer: Aetna Commercial |
$47.09
|
| Rate for Payer: Anthem Medicaid |
$21.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.70
|
| Rate for Payer: Cash Price |
$30.58
|
| Rate for Payer: Cigna Commercial |
$50.76
|
| Rate for Payer: First Health Commercial |
$58.10
|
| Rate for Payer: Humana Commercial |
$51.99
|
| Rate for Payer: Humana KY Medicaid |
$21.03
|
| Rate for Payer: Kentucky WC Medicaid |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.82
|
| Rate for Payer: Ohio Health Group HMO |
$45.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.96
|
| Rate for Payer: PHCS Commercial |
$58.71
|
| Rate for Payer: United Healthcare All Payer |
$53.82
|
|
|
MORPHINE R T 5MG 3ML
|
Facility
|
IP
|
$61.16
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003227
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$58.71 |
| Rate for Payer: Aetna Commercial |
$47.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.70
|
| Rate for Payer: Cash Price |
$30.58
|
| Rate for Payer: Cigna Commercial |
$50.76
|
| Rate for Payer: First Health Commercial |
$58.10
|
| Rate for Payer: Humana Commercial |
$51.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.82
|
| Rate for Payer: Ohio Health Group HMO |
$45.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.96
|
| Rate for Payer: PHCS Commercial |
$58.71
|
| Rate for Payer: United Healthcare All Payer |
$53.82
|
|
|
MORPHINE SDV 10MG(2500MG/50ML)
|
Facility
|
IP
|
$108.04
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25003856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$103.72 |
| Rate for Payer: Aetna Commercial |
$83.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.27
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cigna Commercial |
$89.67
|
| Rate for Payer: First Health Commercial |
$102.64
|
| Rate for Payer: Humana Commercial |
$91.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.08
|
| Rate for Payer: Ohio Health Group HMO |
$81.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.49
|
| Rate for Payer: PHCS Commercial |
$103.72
|
| Rate for Payer: United Healthcare All Payer |
$95.08
|
|
|
MORPHINE SDV 10MG(2500MG/50ML)
|
Facility
|
OP
|
$108.04
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25003856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$103.72 |
| Rate for Payer: Aetna Commercial |
$83.19
|
| Rate for Payer: Anthem Medicaid |
$37.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.27
|
| Rate for Payer: Cash Price |
$54.02
|
| Rate for Payer: Cigna Commercial |
$89.67
|
| Rate for Payer: First Health Commercial |
$102.64
|
| Rate for Payer: Humana Commercial |
$91.83
|
| Rate for Payer: Humana KY Medicaid |
$37.15
|
| Rate for Payer: Kentucky WC Medicaid |
$37.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.08
|
| Rate for Payer: Ohio Health Group HMO |
$81.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.49
|
| Rate for Payer: PHCS Commercial |
$103.72
|
| Rate for Payer: United Healthcare All Payer |
$95.08
|
|
|
MORPHINESULFPF EPID/INTRAT10MG
|
Facility
|
IP
|
$93.84
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$90.09 |
| Rate for Payer: Aetna Commercial |
$72.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.20
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cigna Commercial |
$77.89
|
| Rate for Payer: First Health Commercial |
$89.15
|
| Rate for Payer: Humana Commercial |
$79.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.58
|
| Rate for Payer: Ohio Health Group HMO |
$70.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.09
|
| Rate for Payer: PHCS Commercial |
$90.09
|
| Rate for Payer: United Healthcare All Payer |
$82.58
|
|
|
MORPHINESULFPF EPID/INTRAT10MG
|
Facility
|
OP
|
$93.84
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$90.09 |
| Rate for Payer: Aetna Commercial |
$72.26
|
| Rate for Payer: Anthem Medicaid |
$32.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.20
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cigna Commercial |
$77.89
|
| Rate for Payer: First Health Commercial |
$89.15
|
| Rate for Payer: Humana Commercial |
$79.76
|
| Rate for Payer: Humana KY Medicaid |
$32.27
|
| Rate for Payer: Kentucky WC Medicaid |
$32.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.58
|
| Rate for Payer: Ohio Health Group HMO |
$70.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.09
|
| Rate for Payer: PHCS Commercial |
$90.09
|
| Rate for Payer: United Healthcare All Payer |
$82.58
|
|
|
MOTILITY STUDY
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
32000135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.81 |
| Max. Negotiated Rate |
$803.52 |
| Rate for Payer: Aetna Commercial |
$644.49
|
| Rate for Payer: Anthem Medicaid |
$287.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna Commercial |
$694.71
|
| Rate for Payer: First Health Commercial |
$795.15
|
| Rate for Payer: Humana Commercial |
$711.45
|
| Rate for Payer: Humana KY Medicaid |
$287.84
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$290.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$686.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$617.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$736.56
|
| Rate for Payer: Ohio Health Group HMO |
$627.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.47
|
| Rate for Payer: PHCS Commercial |
$803.52
|
| Rate for Payer: United Healthcare All Payer |
$736.56
|
|
