|
MORPHINE 10mg PF Cartridge
|
Facility
|
OP
|
$77.31
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25004414
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.19 |
| 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 |
$61.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.34
|
| Rate for Payer: PHCS Commercial |
$74.22
|
| Rate for Payer: United Healthcare All Payer |
$68.03
|
|
|
MORPHINE 10mg PF Cartridge
|
Facility
|
IP
|
$77.31
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25004414
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.19 |
| 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 |
$61.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.34
|
| 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 |
$31.19 |
| 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 |
$83.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.73
|
| 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 |
$31.19 |
| 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 |
$83.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.73
|
| Rate for Payer: PHCS Commercial |
$99.80
|
| Rate for Payer: United Healthcare All Payer |
$91.48
|
|
|
MORPHINE 8 MG PF CARTRIDGE
|
Facility
|
OP
|
$77.31
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25004415
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.19 |
| 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 |
$61.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.34
|
| Rate for Payer: PHCS Commercial |
$74.22
|
| Rate for Payer: United Healthcare All Payer |
$68.03
|
|
|
MORPHINE 8 MG PF CARTRIDGE
|
Facility
|
IP
|
$77.31
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25004415
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.19 |
| 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 |
$61.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.34
|
| Rate for Payer: PHCS Commercial |
$74.22
|
| Rate for Payer: United Healthcare All Payer |
$68.03
|
|
|
MORPHINE INJ UP TO 10 MG
|
Facility
|
IP
|
$77.13
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
63600043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.22
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
|
|
MORPHINE INJ UP TO 10 MG
|
Facility
|
IP
|
$77.13
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
636T0043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.22
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
|
|
MORPHINE INJ UP TO 10 MG
|
Facility
|
OP
|
$77.13
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
63600043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Anthem Medicaid |
$26.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Humana KY Medicaid |
$26.53
|
| Rate for Payer: Kentucky WC Medicaid |
$26.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.22
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
|
|
MORPHINE INJ UP TO 10 MG
|
Professional
|
Both
|
$77.13
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
63600043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$46.28 |
| Rate for Payer: Aetna Commercial |
$4.64
|
| Rate for Payer: Ambetter Exchange |
$4.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.46
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Healthspan PPO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.55
|
| Rate for Payer: Multiplan PHCS |
$46.28
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.92
|
| Rate for Payer: UHCCP Medicaid |
$27.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.55
|
|
|
MORPHINE INJ UP TO 10 MG
|
Facility
|
OP
|
$77.13
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
636T0043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$74.04 |
| Rate for Payer: Aetna Commercial |
$59.39
|
| Rate for Payer: Anthem Medicaid |
$26.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.16
|
| Rate for Payer: Cash Price |
$38.56
|
| Rate for Payer: Cigna Commercial |
$64.02
|
| Rate for Payer: First Health Commercial |
$73.27
|
| Rate for Payer: Humana Commercial |
$65.56
|
| Rate for Payer: Humana KY Medicaid |
$26.53
|
| Rate for Payer: Kentucky WC Medicaid |
$26.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.87
|
| Rate for Payer: Ohio Health Group HMO |
$57.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.22
|
| Rate for Payer: PHCS Commercial |
$74.04
|
| Rate for Payer: United Healthcare All Payer |
$67.87
|
|
|
MORPHINE (IR) 30 MG TABLET
|
Facility
|
IP
|
$60.74
|
|
|
Service Code
|
NDC 54023625
|
| Hospital Charge Code |
25003220
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.22 |
| 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 |
$45.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.91
|
| 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 |
$18.22 |
| 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 |
$45.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.91
|
| Rate for Payer: PHCS Commercial |
$58.31
|
| Rate for Payer: United Healthcare All Payer |
$53.45
|
|
|
MORPHINE R T 10MG 3ML
|
Facility
|
IP
|
$61.27
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003224
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.79
|
| Rate for Payer: Cash Price |
$30.64
|
| Rate for Payer: Cigna Commercial |
$50.85
|
| Rate for Payer: First Health Commercial |
$58.21
|
| Rate for Payer: Humana Commercial |
$52.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.92
|
| Rate for Payer: Ohio Health Group HMO |
$45.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.28
|
| Rate for Payer: PHCS Commercial |
$58.82
|
| Rate for Payer: United Healthcare All Payer |
$53.92
|
|
|
MORPHINE R T 10MG 3ML
|
Facility
|
OP
|
$61.27
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003224
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: Anthem Medicaid |
$21.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.79
|
| Rate for Payer: Cash Price |
$30.64
|
| Rate for Payer: Cigna Commercial |
$50.85
|
| Rate for Payer: First Health Commercial |
$58.21
|
| Rate for Payer: Humana Commercial |
$52.08
|
| Rate for Payer: Humana KY Medicaid |
$21.07
|
| Rate for Payer: Kentucky WC Medicaid |
$21.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.92
|
| Rate for Payer: Ohio Health Group HMO |
$45.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.28
|
| Rate for Payer: PHCS Commercial |
$58.82
|
| Rate for Payer: United Healthcare All Payer |
$53.92
|
|
|
MORPHINE R T 15MG 3ML
|
Facility
|
OP
|
$61.37
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$58.92 |
| Rate for Payer: Aetna Commercial |
$47.25
|
| Rate for Payer: Anthem Medicaid |
$21.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.87
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna Commercial |
$50.94
|
| Rate for Payer: First Health Commercial |
$58.30
|
| Rate for Payer: Humana Commercial |
$52.16
|
| Rate for Payer: Humana KY Medicaid |
$21.11
|
| Rate for Payer: Kentucky WC Medicaid |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.01
|
| Rate for Payer: Ohio Health Group HMO |
$46.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.35
|
| Rate for Payer: PHCS Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Payer |
$54.01
|
|
|
MORPHINE R T 15MG 3ML
|
Facility
|
IP
|
$61.37
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.41 |
| Max. Negotiated Rate |
$58.92 |
| Rate for Payer: Aetna Commercial |
$47.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.87
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Cigna Commercial |
$50.94
|
| Rate for Payer: First Health Commercial |
$58.30
|
| Rate for Payer: Humana Commercial |
$52.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.01
|
| Rate for Payer: Ohio Health Group HMO |
$46.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.35
|
| Rate for Payer: PHCS Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Payer |
$54.01
|
|
|
MORPHINE R T 20MG 3ML
|
Facility
|
OP
|
$61.48
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$59.02 |
| Rate for Payer: Aetna Commercial |
$47.34
|
| Rate for Payer: Anthem Medicaid |
$21.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.95
|
| Rate for Payer: Cash Price |
$30.74
|
| Rate for Payer: Cigna Commercial |
$51.03
|
| Rate for Payer: First Health Commercial |
$58.41
|
| Rate for Payer: Humana Commercial |
$52.26
|
| Rate for Payer: Humana KY Medicaid |
$21.14
|
| Rate for Payer: Kentucky WC Medicaid |
$21.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.10
|
| Rate for Payer: Ohio Health Group HMO |
$46.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.42
|
| Rate for Payer: PHCS Commercial |
$59.02
|
| Rate for Payer: United Healthcare All Payer |
$54.10
|
|
|
MORPHINE R T 20MG 3ML
|
Facility
|
IP
|
$61.48
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003226
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$59.02 |
| Rate for Payer: Aetna Commercial |
$47.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.95
|
| Rate for Payer: Cash Price |
$30.74
|
| Rate for Payer: Cigna Commercial |
$51.03
|
| Rate for Payer: First Health Commercial |
$58.41
|
| Rate for Payer: Humana Commercial |
$52.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$54.10
|
| Rate for Payer: Ohio Health Group HMO |
$46.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.42
|
| Rate for Payer: PHCS Commercial |
$59.02
|
| Rate for Payer: United Healthcare All Payer |
$54.10
|
|
|
MORPHINE R T 5MG 3ML
|
Facility
|
OP
|
$61.17
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003227
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$58.72 |
| Rate for Payer: Aetna Commercial |
$47.10
|
| Rate for Payer: Anthem Medicaid |
$21.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.71
|
| Rate for Payer: Cash Price |
$30.59
|
| Rate for Payer: Cigna Commercial |
$50.77
|
| Rate for Payer: First Health Commercial |
$58.11
|
| Rate for Payer: Humana Commercial |
$51.99
|
| Rate for Payer: Humana KY Medicaid |
$21.04
|
| Rate for Payer: Kentucky WC Medicaid |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.16
|
| 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 |
$21.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.83
|
| Rate for Payer: Ohio Health Group HMO |
$45.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.21
|
| Rate for Payer: PHCS Commercial |
$58.72
|
| Rate for Payer: United Healthcare All Payer |
$53.83
|
|
|
MORPHINE R T 5MG 3ML
|
Facility
|
IP
|
$61.17
|
|
|
Service Code
|
NDC 409189620
|
| Hospital Charge Code |
25003227
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$58.72 |
| Rate for Payer: Aetna Commercial |
$47.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.71
|
| Rate for Payer: Cash Price |
$30.59
|
| Rate for Payer: Cigna Commercial |
$50.77
|
| Rate for Payer: First Health Commercial |
$58.11
|
| Rate for Payer: Humana Commercial |
$51.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.16
|
| 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 |
$53.83
|
| Rate for Payer: Ohio Health Group HMO |
$45.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.21
|
| Rate for Payer: PHCS Commercial |
$58.72
|
| Rate for Payer: United Healthcare All Payer |
$53.83
|
|
|
MORPHINE SDV 10MG(2500MG/50ML)
|
Facility
|
IP
|
$108.04
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25003856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.41 |
| 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 |
$86.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.55
|
| 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 |
$32.41 |
| 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 |
$86.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.55
|
| Rate for Payer: PHCS Commercial |
$103.72
|
| Rate for Payer: United Healthcare All Payer |
$95.08
|
|
|
MORPHINESULFPF EPID/INTRAT10MG
|
Facility
|
OP
|
$96.76
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$92.89 |
| Rate for Payer: Aetna Commercial |
$74.51
|
| Rate for Payer: Anthem Medicaid |
$33.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.47
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cigna Commercial |
$80.31
|
| Rate for Payer: First Health Commercial |
$91.92
|
| Rate for Payer: Humana Commercial |
$82.25
|
| Rate for Payer: Humana KY Medicaid |
$33.28
|
| Rate for Payer: Kentucky WC Medicaid |
$33.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.15
|
| Rate for Payer: Ohio Health Group HMO |
$72.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.76
|
| Rate for Payer: PHCS Commercial |
$92.89
|
| Rate for Payer: United Healthcare All Payer |
$85.15
|
|
|
MORPHINESULFPF EPID/INTRAT10MG
|
Facility
|
IP
|
$96.76
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
25002248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$92.89 |
| Rate for Payer: Aetna Commercial |
$74.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.47
|
| Rate for Payer: Cash Price |
$48.38
|
| Rate for Payer: Cigna Commercial |
$80.31
|
| Rate for Payer: First Health Commercial |
$91.92
|
| Rate for Payer: Humana Commercial |
$82.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.15
|
| Rate for Payer: Ohio Health Group HMO |
$72.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.76
|
| Rate for Payer: PHCS Commercial |
$92.89
|
| Rate for Payer: United Healthcare All Payer |
$85.15
|
|
