|
MOTILITY STUDY
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
32000135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Aetna Commercial |
$681.45
|
| Rate for Payer: Anthem Medicaid |
$304.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$690.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cigna Commercial |
$734.55
|
| Rate for Payer: First Health Commercial |
$840.75
|
| Rate for Payer: Humana Commercial |
$752.25
|
| Rate for Payer: Humana KY Medicaid |
$304.35
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$307.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$725.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$653.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$310.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$778.80
|
| Rate for Payer: Ohio Health Group HMO |
$663.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$708.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$610.65
|
| Rate for Payer: PHCS Commercial |
$849.60
|
| Rate for Payer: United Healthcare All Payer |
$778.80
|
|
|
MOTILITY STUDY
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
32000135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Aetna Commercial |
$681.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$690.30
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cigna Commercial |
$734.55
|
| Rate for Payer: First Health Commercial |
$840.75
|
| Rate for Payer: Humana Commercial |
$752.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$725.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$653.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$778.80
|
| Rate for Payer: Ohio Health Group HMO |
$663.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$708.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$610.65
|
| Rate for Payer: PHCS Commercial |
$849.60
|
| Rate for Payer: United Healthcare All Payer |
$778.80
|
|
|
MOTILITY STUDY
|
Professional
|
Both
|
$885.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
32000135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Aetna Commercial |
$151.82
|
| Rate for Payer: Ambetter Exchange |
$108.61
|
| Rate for Payer: Anthem Medicaid |
$91.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$108.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$108.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$130.33
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cash Price |
$442.50
|
| Rate for Payer: Cigna Commercial |
$122.55
|
| Rate for Payer: Healthspan PPO |
$142.26
|
| Rate for Payer: Humana Medicaid |
$91.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$108.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.85
|
| Rate for Payer: Molina Healthcare Passport |
$91.03
|
| Rate for Payer: Multiplan PHCS |
$531.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$141.19
|
| Rate for Payer: UHCCP Medicaid |
$309.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$108.61
|
|
|
MOTILITY STUDY(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
320P0135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$151.82 |
| Rate for Payer: Aetna Commercial |
$151.82
|
| Rate for Payer: Ambetter Exchange |
$108.61
|
| Rate for Payer: Anthem Medicaid |
$91.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$108.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$108.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$130.33
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$122.55
|
| Rate for Payer: Healthspan PPO |
$142.26
|
| Rate for Payer: Humana Medicaid |
$91.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$108.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.85
|
| Rate for Payer: Molina Healthcare Passport |
$91.03
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$141.19
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$108.61
|
|
|
MOTILITY STUDY(T
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
320T0135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
MOTILITY STUDY(T
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
320T0135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem Medicaid |
$269.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Humana KY Medicaid |
$269.96
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$272.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
MOTION FLUOROSCOPY/SWALLOW
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
HCPCS 92611
|
| Hospital Charge Code |
44000014
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$514.56 |
| Rate for Payer: Aetna Commercial |
$412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.08
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cigna Commercial |
$444.88
|
| Rate for Payer: First Health Commercial |
$509.20
|
| Rate for Payer: Humana Commercial |
$455.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$439.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.68
|
| Rate for Payer: Ohio Health Group HMO |
$402.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.84
|
| Rate for Payer: PHCS Commercial |
$514.56
|
| Rate for Payer: United Healthcare All Payer |
$471.68
|
|
|
MOTION FLUOROSCOPY/SWALLOW
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
HCPCS 92611
|
| Hospital Charge Code |
44000014
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$514.56 |
| Rate for Payer: Aetna Commercial |
$412.72
|
| Rate for Payer: Anthem Medicaid |
$184.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.08
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cigna Commercial |
$444.88
|
| Rate for Payer: First Health Commercial |
$509.20
|
| Rate for Payer: Humana Commercial |
$455.60
|
| Rate for Payer: Humana KY Medicaid |
$184.33
|
| Rate for Payer: Kentucky WC Medicaid |
$186.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$439.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.68
|
| Rate for Payer: Ohio Health Group HMO |
$402.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.84
|
| Rate for Payer: PHCS Commercial |
$514.56
|
| Rate for Payer: United Healthcare All Payer |
$471.68
|
|
|
MOTRIN 200MG TAB
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
NDC 904791461
|
| Hospital Charge Code |
25001013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.06
|
| Rate for Payer: Humana Commercial |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.76
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Payer |
$3.76
|
|
|
MOTRIN 200MG TAB
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
NDC 904791461
|
| Hospital Charge Code |
25001013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.06
|
| Rate for Payer: Humana Commercial |
$3.63
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.76
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Payer |
$3.76
|
|
|
MOTRIN (IBUPROFEN) 400MG/1TAB
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
NDC 904585361
|
| Hospital Charge Code |
25001011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.06
|
| Rate for Payer: Humana Commercial |
$3.63
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.76
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Payer |
$3.76
|
|
|
MOTRIN (IBUPROFEN) 400MG/1TAB
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
NDC 904585361
|
| Hospital Charge Code |
25001011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.06
|
| Rate for Payer: Humana Commercial |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.76
|
| Rate for Payer: Ohio Health Group HMO |
$3.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Payer |
$3.76
|
|
|
MOTRIN (IBUPROFEN) 600MG/1TAB
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 904585461
|
| Hospital Charge Code |
25001012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
MOTRIN (IBUPROFEN) 600MG/1TAB
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 904585461
|
| Hospital Charge Code |
25001012
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
MOXIFLOXACIN 150MCG/0.1ML (1ML
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
25003233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem Medicaid |
$38.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Humana KY Medicaid |
$38.52
|
| Rate for Payer: Kentucky WC Medicaid |
$38.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.28
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
MOXIFLOXACIN 150MCG/0.1ML (1ML
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
25003233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.36
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$92.96
|
| Rate for Payer: First Health Commercial |
$106.40
|
| Rate for Payer: Humana Commercial |
$95.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.56
|
| Rate for Payer: Ohio Health Group HMO |
$84.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.28
|
| Rate for Payer: PHCS Commercial |
$107.52
|
| Rate for Payer: United Healthcare All Payer |
$98.56
|
|
|
MOXIFLOXACIN HCL 400MG TAB
|
Facility
|
OP
|
$23.75
|
|
|
Service Code
|
NDC 50268057613
|
| Hospital Charge Code |
25003857
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.52
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cigna Commercial |
$19.71
|
| Rate for Payer: First Health Commercial |
$22.56
|
| Rate for Payer: Humana Commercial |
$20.19
|
| Rate for Payer: Humana KY Medicaid |
$8.17
|
| Rate for Payer: Kentucky WC Medicaid |
$8.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.90
|
| Rate for Payer: Ohio Health Group HMO |
$17.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.39
|
| Rate for Payer: PHCS Commercial |
$22.80
|
| Rate for Payer: United Healthcare All Payer |
$20.90
|
|
|
MOXIFLOXACIN HCL 400MG TAB
|
Facility
|
IP
|
$23.75
|
|
|
Service Code
|
NDC 50268057613
|
| Hospital Charge Code |
25003857
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.52
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cigna Commercial |
$19.71
|
| Rate for Payer: First Health Commercial |
$22.56
|
| Rate for Payer: Humana Commercial |
$20.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.90
|
| Rate for Payer: Ohio Health Group HMO |
$17.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.39
|
| Rate for Payer: PHCS Commercial |
$22.80
|
| Rate for Payer: United Healthcare All Payer |
$20.90
|
|
|
MPA 1 115CM
|
Facility
|
OP
|
$1,874.56
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.37 |
| Max. Negotiated Rate |
$1,799.58 |
| Rate for Payer: Aetna Commercial |
$1,443.41
|
| Rate for Payer: Anthem Medicaid |
$644.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.16
|
| Rate for Payer: Cash Price |
$937.28
|
| Rate for Payer: Cigna Commercial |
$1,555.88
|
| Rate for Payer: First Health Commercial |
$1,780.83
|
| Rate for Payer: Humana Commercial |
$1,593.38
|
| Rate for Payer: Humana KY Medicaid |
$644.66
|
| Rate for Payer: Kentucky WC Medicaid |
$651.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,649.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.45
|
| Rate for Payer: PHCS Commercial |
$1,799.58
|
| Rate for Payer: United Healthcare All Payer |
$1,649.61
|
|
|
MPA 1 115CM
|
Facility
|
IP
|
$1,874.56
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.37 |
| Max. Negotiated Rate |
$1,799.58 |
| Rate for Payer: Aetna Commercial |
$1,443.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.16
|
| Rate for Payer: Cash Price |
$937.28
|
| Rate for Payer: Cigna Commercial |
$1,555.88
|
| Rate for Payer: First Health Commercial |
$1,780.83
|
| Rate for Payer: Humana Commercial |
$1,593.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,649.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.45
|
| Rate for Payer: PHCS Commercial |
$1,799.58
|
| Rate for Payer: United Healthcare All Payer |
$1,649.61
|
|
|
MPA-1 5FR
|
Facility
|
IP
|
$157.61
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.28 |
| Max. Negotiated Rate |
$151.31 |
| Rate for Payer: Aetna Commercial |
$121.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.94
|
| Rate for Payer: Cash Price |
$78.81
|
| Rate for Payer: Cigna Commercial |
$130.82
|
| Rate for Payer: First Health Commercial |
$149.73
|
| Rate for Payer: Humana Commercial |
$133.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$129.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.70
|
| Rate for Payer: Ohio Health Group HMO |
$118.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.75
|
| Rate for Payer: PHCS Commercial |
$151.31
|
| Rate for Payer: United Healthcare All Payer |
$138.70
|
|
|
MPA-1 5FR
|
Facility
|
OP
|
$157.61
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.28 |
| Max. Negotiated Rate |
$151.31 |
| Rate for Payer: Aetna Commercial |
$121.36
|
| Rate for Payer: Anthem Medicaid |
$54.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.94
|
| Rate for Payer: Cash Price |
$78.81
|
| Rate for Payer: Cigna Commercial |
$130.82
|
| Rate for Payer: First Health Commercial |
$149.73
|
| Rate for Payer: Humana Commercial |
$133.97
|
| Rate for Payer: Humana KY Medicaid |
$54.20
|
| Rate for Payer: Kentucky WC Medicaid |
$54.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$129.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$55.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.70
|
| Rate for Payer: Ohio Health Group HMO |
$118.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.75
|
| Rate for Payer: PHCS Commercial |
$151.31
|
| Rate for Payer: United Healthcare All Payer |
$138.70
|
|
|
MPA 1 GUIDE 125CM
|
Facility
|
IP
|
$1,874.56
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.37 |
| Max. Negotiated Rate |
$1,799.58 |
| Rate for Payer: Aetna Commercial |
$1,443.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.16
|
| Rate for Payer: Cash Price |
$937.28
|
| Rate for Payer: Cigna Commercial |
$1,555.88
|
| Rate for Payer: First Health Commercial |
$1,780.83
|
| Rate for Payer: Humana Commercial |
$1,593.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,649.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.45
|
| Rate for Payer: PHCS Commercial |
$1,799.58
|
| Rate for Payer: United Healthcare All Payer |
$1,649.61
|
|
|
MPA 1 GUIDE 125CM
|
Facility
|
OP
|
$1,874.56
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.37 |
| Max. Negotiated Rate |
$1,799.58 |
| Rate for Payer: Aetna Commercial |
$1,443.41
|
| Rate for Payer: Anthem Medicaid |
$644.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.16
|
| Rate for Payer: Cash Price |
$937.28
|
| Rate for Payer: Cigna Commercial |
$1,555.88
|
| Rate for Payer: First Health Commercial |
$1,780.83
|
| Rate for Payer: Humana Commercial |
$1,593.38
|
| Rate for Payer: Humana KY Medicaid |
$644.66
|
| Rate for Payer: Kentucky WC Medicaid |
$651.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,649.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.45
|
| Rate for Payer: PHCS Commercial |
$1,799.58
|
| Rate for Payer: United Healthcare All Payer |
$1,649.61
|
|
|
MPA 1 GUIDE CATH 6F 110CM
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
