|
MIDLINE INSRT/COMPLEX VENIPUNC
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
761T2668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$235.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.68
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$253.98
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: Humana Commercial |
$260.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$269.28
|
| Rate for Payer: Ohio Health Group HMO |
$229.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.14
|
| Rate for Payer: PHCS Commercial |
$293.76
|
| Rate for Payer: United Healthcare All Payer |
$269.28
|
|
|
MIDLINE INSRT/COMPLEX VENIPUNC
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
76102668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$504.96 |
| Rate for Payer: Aetna Commercial |
$405.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$410.28
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna Commercial |
$436.58
|
| Rate for Payer: First Health Commercial |
$499.70
|
| Rate for Payer: Humana Commercial |
$447.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$431.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$388.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.88
|
| Rate for Payer: Ohio Health Group HMO |
$394.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.94
|
| Rate for Payer: PHCS Commercial |
$504.96
|
| Rate for Payer: United Healthcare All Payer |
$462.88
|
|
|
MIDLINE INSRT/COMPLEX VENIPUNC
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
761P2668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$13.78
|
| Rate for Payer: Ambetter Exchange |
$8.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.49
|
| Rate for Payer: Anthem Medicaid |
$11.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.26
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: Healthspan PPO |
$22.14
|
| Rate for Payer: Humana Medicaid |
$11.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$11.90
|
| Rate for Payer: Molina Healthcare Passport |
$11.67
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.12
|
| Rate for Payer: UHCCP Medicaid |
$7.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.55
|
|
|
MIDLINE INSRT/COMPLEX VENIPUNC
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
76102668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$504.96 |
| Rate for Payer: Aetna Commercial |
$405.02
|
| Rate for Payer: Anthem Medicaid |
$180.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$410.28
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna Commercial |
$436.58
|
| Rate for Payer: First Health Commercial |
$499.70
|
| Rate for Payer: Humana Commercial |
$447.10
|
| Rate for Payer: Humana KY Medicaid |
$180.89
|
| Rate for Payer: Kentucky WC Medicaid |
$182.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$431.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$388.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$184.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.88
|
| Rate for Payer: Ohio Health Group HMO |
$394.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.94
|
| Rate for Payer: PHCS Commercial |
$504.96
|
| Rate for Payer: United Healthcare All Payer |
$462.88
|
|
|
MIDLINE INSRT/COMPLEX VENIPUNC
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
761T2668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$235.62
|
| Rate for Payer: Anthem Medicaid |
$105.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.68
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$253.98
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: Humana Commercial |
$260.10
|
| Rate for Payer: Humana KY Medicaid |
$105.23
|
| Rate for Payer: Kentucky WC Medicaid |
$106.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$107.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$269.28
|
| Rate for Payer: Ohio Health Group HMO |
$229.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.14
|
| Rate for Payer: PHCS Commercial |
$293.76
|
| Rate for Payer: United Healthcare All Payer |
$269.28
|
|
|
MIDLINE INSRT/COMPLEX VENIPUNC
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
76102668
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$315.60 |
| Rate for Payer: Aetna Commercial |
$13.78
|
| Rate for Payer: Ambetter Exchange |
$8.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.49
|
| Rate for Payer: Anthem Medicaid |
$11.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.26
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: Healthspan PPO |
$22.14
|
| Rate for Payer: Humana Medicaid |
$11.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$11.90
|
| Rate for Payer: Molina Healthcare Passport |
$11.67
|
| Rate for Payer: Multiplan PHCS |
$315.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.12
|
| Rate for Payer: UHCCP Medicaid |
$7.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.55
|
|
|
MIDODRINE 10MG TAB
|
Facility
|
OP
|
$4.20
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004540
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Anthem Medicaid |
$1.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$3.99
|
| Rate for Payer: Humana Commercial |
$3.57
|
| Rate for Payer: Humana KY Medicaid |
$1.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$4.03
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
MIDODRINE 10MG TAB
|
Facility
|
IP
|
$4.20
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
25004540
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$3.99
|
| Rate for Payer: Humana Commercial |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$4.03
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
MIKAELSSON CATH
|
Facility
|
IP
|
$439.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.78 |
| Max. Negotiated Rate |
$421.68 |
| Rate for Payer: Aetna Commercial |
$338.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.62
|
| Rate for Payer: Cash Price |
$219.62
|
| Rate for Payer: Cigna Commercial |
$364.58
|
| Rate for Payer: First Health Commercial |
$417.29
|
| Rate for Payer: Humana Commercial |
$373.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.54
|
| Rate for Payer: Ohio Health Group HMO |
$329.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.08
|
| Rate for Payer: PHCS Commercial |
$421.68
|
| Rate for Payer: United Healthcare All Payer |
$386.54
|
|
|
MIKAELSSON CATH
|
Facility
|
OP
|
$439.25
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.78 |
| Max. Negotiated Rate |
$421.68 |
| Rate for Payer: Aetna Commercial |
$338.22
|
| Rate for Payer: Anthem Medicaid |
$151.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$342.62
|
| Rate for Payer: Cash Price |
$219.62
|
| Rate for Payer: Cigna Commercial |
$364.58
|
| Rate for Payer: First Health Commercial |
$417.29
|
| Rate for Payer: Humana Commercial |
$373.36
|
| Rate for Payer: Humana KY Medicaid |
$151.06
|
| Rate for Payer: Kentucky WC Medicaid |
$152.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$386.54
|
| Rate for Payer: Ohio Health Group HMO |
$329.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.08
|
| Rate for Payer: PHCS Commercial |
$421.68
|
| Rate for Payer: United Healthcare All Payer |
$386.54
|
|
|
MILK OF MAGNESIA SUSP(MG 30ML
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 57896064916
|
| Hospital Charge Code |
25000985
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
MILK OF MAGNESIA SUSP(MG 30ML
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 57896064916
|
| Hospital Charge Code |
25000985
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
MINERAL OIL 2 ML VIAL
|
Facility
|
OP
|
$36.71
|
|
|
Service Code
|
NDC 63323025402
|
| Hospital Charge Code |
25004119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$35.24 |
| Rate for Payer: Aetna Commercial |
$28.27
|
| Rate for Payer: Anthem Medicaid |
$12.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.63
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cigna Commercial |
$30.47
|
| Rate for Payer: First Health Commercial |
$34.87
|
| Rate for Payer: Humana Commercial |
$31.20
|
| Rate for Payer: Humana KY Medicaid |
$12.62
|
| Rate for Payer: Kentucky WC Medicaid |
$12.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.30
|
| Rate for Payer: Ohio Health Group HMO |
$27.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.33
|
| Rate for Payer: PHCS Commercial |
$35.24
|
| Rate for Payer: United Healthcare All Payer |
$32.30
|
|
|
MINERAL OIL 2 ML VIAL
|
Facility
|
IP
|
$36.71
|
|
|
Service Code
|
NDC 63323025402
|
| Hospital Charge Code |
25004119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$35.24 |
| Rate for Payer: Aetna Commercial |
$28.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.63
|
| Rate for Payer: Cash Price |
$18.36
|
| Rate for Payer: Cigna Commercial |
$30.47
|
| Rate for Payer: First Health Commercial |
$34.87
|
| Rate for Payer: Humana Commercial |
$31.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.30
|
| Rate for Payer: Ohio Health Group HMO |
$27.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.33
|
| Rate for Payer: PHCS Commercial |
$35.24
|
| Rate for Payer: United Healthcare All Payer |
$32.30
|
|
|
MINERAL OIL 30 ML 30ML
|
Facility
|
IP
|
$4.57
|
|
|
Service Code
|
NDC 46122039516
|
| Hospital Charge Code |
25000986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
MINERAL OIL 30 ML 30ML
|
Facility
|
OP
|
$4.57
|
|
|
Service Code
|
NDC 46122039516
|
| Hospital Charge Code |
25000986
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$4.39 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Anthem Medicaid |
$1.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cigna Commercial |
$3.79
|
| Rate for Payer: First Health Commercial |
$4.34
|
| Rate for Payer: Humana Commercial |
$3.88
|
| Rate for Payer: Humana KY Medicaid |
$1.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.02
|
| Rate for Payer: Ohio Health Group HMO |
$3.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.15
|
| Rate for Payer: PHCS Commercial |
$4.39
|
| Rate for Payer: United Healthcare All Payer |
$4.02
|
|
|
MINERAL OIL LIGHT STERILE 10ML
|
Facility
|
IP
|
$39.78
|
|
|
Service Code
|
NDC 63323025410
|
| Hospital Charge Code |
25000987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$38.19 |
| Rate for Payer: Aetna Commercial |
$30.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.03
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Cigna Commercial |
$33.02
|
| Rate for Payer: First Health Commercial |
$37.79
|
| Rate for Payer: Humana Commercial |
$33.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.01
|
| Rate for Payer: Ohio Health Group HMO |
$29.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.45
|
| Rate for Payer: PHCS Commercial |
$38.19
|
| Rate for Payer: United Healthcare All Payer |
$35.01
|
|
|
MINERAL OIL LIGHT STERILE 10ML
|
Facility
|
OP
|
$39.78
|
|
|
Service Code
|
NDC 63323025410
|
| Hospital Charge Code |
25000987
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$38.19 |
| Rate for Payer: Aetna Commercial |
$30.63
|
| Rate for Payer: Anthem Medicaid |
$13.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.03
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Cigna Commercial |
$33.02
|
| Rate for Payer: First Health Commercial |
$37.79
|
| Rate for Payer: Humana Commercial |
$33.81
|
| Rate for Payer: Humana KY Medicaid |
$13.68
|
| Rate for Payer: Kentucky WC Medicaid |
$13.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.01
|
| Rate for Payer: Ohio Health Group HMO |
$29.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.45
|
| Rate for Payer: PHCS Commercial |
$38.19
|
| Rate for Payer: United Healthcare All Payer |
$35.01
|
|
|
MINI-INCISION SYSTEM
|
Facility
|
OP
|
$27,481.25
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,244.38 |
| Max. Negotiated Rate |
$26,382.00 |
| Rate for Payer: Aetna Commercial |
$21,160.56
|
| Rate for Payer: Anthem Medicaid |
$9,450.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,435.38
|
| Rate for Payer: Cash Price |
$13,740.62
|
| Rate for Payer: Cigna Commercial |
$22,809.44
|
| Rate for Payer: First Health Commercial |
$26,107.19
|
| Rate for Payer: Humana Commercial |
$23,359.06
|
| Rate for Payer: Humana KY Medicaid |
$9,450.80
|
| Rate for Payer: Kentucky WC Medicaid |
$9,546.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,534.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,281.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,244.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,640.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,183.50
|
| Rate for Payer: Ohio Health Group HMO |
$20,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,908.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,962.06
|
| Rate for Payer: PHCS Commercial |
$26,382.00
|
| Rate for Payer: United Healthcare All Payer |
$24,183.50
|
|
|
MINI-INCISION SYSTEM
|
Facility
|
IP
|
$27,481.25
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,244.38 |
| Max. Negotiated Rate |
$26,382.00 |
| Rate for Payer: Aetna Commercial |
$21,160.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,435.38
|
| Rate for Payer: Cash Price |
$13,740.62
|
| Rate for Payer: Cigna Commercial |
$22,809.44
|
| Rate for Payer: First Health Commercial |
$26,107.19
|
| Rate for Payer: Humana Commercial |
$23,359.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,534.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,281.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,244.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,183.50
|
| Rate for Payer: Ohio Health Group HMO |
$20,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,908.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,962.06
|
| Rate for Payer: PHCS Commercial |
$26,382.00
|
| Rate for Payer: United Healthcare All Payer |
$24,183.50
|
|
|
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 |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$547.99
|
| Rate for Payer: Ambetter Exchange |
$351.00
|
| Rate for Payer: Anthem Medicaid |
$271.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$351.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$351.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$351.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.19
|
| 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 |
$456.30
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$351.00
|
|
|
MINI LAPAROTOMY
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58600
|
| Hospital Charge Code |
76102244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
MINI LAPAROTOMY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 58600
|
| Hospital Charge Code |
76102244
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| 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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
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 |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$547.99
|
| Rate for Payer: Ambetter Exchange |
$351.00
|
| Rate for Payer: Anthem Medicaid |
$271.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$351.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$351.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$351.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$277.19
|
| 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 |
$456.30
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$351.00
|
|
|
MINI MIIG X3 INJ GRAFT 5CC
|
Facility
|
IP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
