|
MTR FUSION LEFT ACUMED
|
Facility
|
OP
|
$2,176.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.99 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,676.20
|
| Rate for Payer: Anthem Medicaid |
$748.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.97
|
| Rate for Payer: Cash Price |
$1,088.44
|
| Rate for Payer: Cigna Commercial |
$1,806.81
|
| Rate for Payer: First Health Commercial |
$2,068.04
|
| Rate for Payer: Humana Commercial |
$1,850.35
|
| Rate for Payer: Humana KY Medicaid |
$748.63
|
| Rate for Payer: Kentucky WC Medicaid |
$756.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.83
|
| Rate for Payer: PHCS Commercial |
$2,089.80
|
| Rate for Payer: United Healthcare All Payer |
$1,915.65
|
|
|
MTR FUSION LEFT ACUMED
|
Facility
|
IP
|
$2,176.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.99 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,676.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.97
|
| Rate for Payer: Cash Price |
$1,088.44
|
| Rate for Payer: Cigna Commercial |
$1,806.81
|
| Rate for Payer: First Health Commercial |
$2,068.04
|
| Rate for Payer: Humana Commercial |
$1,850.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.83
|
| Rate for Payer: PHCS Commercial |
$2,089.80
|
| Rate for Payer: United Healthcare All Payer |
$1,915.65
|
|
|
MTX CEM 14/16 TPR SZ8S 8DD125L
|
Facility
|
OP
|
$13,367.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.79 |
| Max. Negotiated Rate |
$12,832.91 |
| Rate for Payer: Aetna Commercial |
$10,293.06
|
| Rate for Payer: Anthem Medicaid |
$4,597.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,426.74
|
| Rate for Payer: Cash Price |
$6,683.81
|
| Rate for Payer: Cigna Commercial |
$11,095.12
|
| Rate for Payer: First Health Commercial |
$12,699.23
|
| Rate for Payer: Humana Commercial |
$11,362.47
|
| Rate for Payer: Humana KY Medicaid |
$4,597.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,643.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,961.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,865.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,010.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,689.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,763.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,025.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,143.96
|
| Rate for Payer: PHCS Commercial |
$12,832.91
|
| Rate for Payer: United Healthcare All Payer |
$11,763.50
|
|
|
MTX CEM 14/16 TPR SZ8S 8DD125L
|
Facility
|
IP
|
$13,367.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.79 |
| Max. Negotiated Rate |
$12,832.91 |
| Rate for Payer: Aetna Commercial |
$10,293.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,426.74
|
| Rate for Payer: Cash Price |
$6,683.81
|
| Rate for Payer: Cigna Commercial |
$11,095.12
|
| Rate for Payer: First Health Commercial |
$12,699.23
|
| Rate for Payer: Humana Commercial |
$11,362.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,961.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,865.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,010.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,763.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,025.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,143.96
|
| Rate for Payer: PHCS Commercial |
$12,832.91
|
| Rate for Payer: United Healthcare All Payer |
$11,763.50
|
|
|
MTX CM 14/16 TPR 10S 10DD 135L
|
Facility
|
OP
|
$13,367.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.79 |
| Max. Negotiated Rate |
$12,832.91 |
| Rate for Payer: Aetna Commercial |
$10,293.06
|
| Rate for Payer: Anthem Medicaid |
$4,597.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,426.74
|
| Rate for Payer: Cash Price |
$6,683.81
|
| Rate for Payer: Cigna Commercial |
$11,095.12
|
| Rate for Payer: First Health Commercial |
$12,699.23
|
| Rate for Payer: Humana Commercial |
$11,362.47
|
| Rate for Payer: Humana KY Medicaid |
$4,597.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,643.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,961.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,865.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,010.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,689.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,763.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,025.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,143.96
|
| Rate for Payer: PHCS Commercial |
$12,832.91
|
| Rate for Payer: United Healthcare All Payer |
$11,763.50
|
|
|
MTX CM 14/16 TPR 10S 10DD 135L
|
Facility
|
IP
|
$13,367.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.79 |
| Max. Negotiated Rate |
$12,832.91 |
| Rate for Payer: Aetna Commercial |
$10,293.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,426.74
|
| Rate for Payer: Cash Price |
$6,683.81
|
| Rate for Payer: Cigna Commercial |
$11,095.12
|
| Rate for Payer: First Health Commercial |
$12,699.23
|
| Rate for Payer: Humana Commercial |
$11,362.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,961.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,865.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,010.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,763.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,025.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,143.96
|
| Rate for Payer: PHCS Commercial |
$12,832.91
|
| Rate for Payer: United Healthcare All Payer |
$11,763.50
|
|
|
MTX CM 14/16 TPR 14S 14DD 155L
|
Facility
|
IP
|
$13,367.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.79 |
| Max. Negotiated Rate |
$12,832.91 |
| Rate for Payer: Aetna Commercial |
$10,293.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,426.74
|
| Rate for Payer: Cash Price |
$6,683.81
|
| Rate for Payer: Cigna Commercial |
$11,095.12
|
| Rate for Payer: First Health Commercial |
$12,699.23
|
| Rate for Payer: Humana Commercial |
$11,362.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,961.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,865.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,010.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,763.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,025.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,143.96
|
| Rate for Payer: PHCS Commercial |
$12,832.91
|
| Rate for Payer: United Healthcare All Payer |
$11,763.50
|
|
|
MTX CM 14/16 TPR 14S 14DD 155L
|
Facility
|
OP
|
$13,367.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.79 |
| Max. Negotiated Rate |
$12,832.91 |
| Rate for Payer: Aetna Commercial |
$10,293.06
|
| Rate for Payer: Anthem Medicaid |
$4,597.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,426.74
|
| Rate for Payer: Cash Price |
$6,683.81
|
| Rate for Payer: Cigna Commercial |
$11,095.12
|
| Rate for Payer: First Health Commercial |
$12,699.23
|
| Rate for Payer: Humana Commercial |
$11,362.47
|
| Rate for Payer: Humana KY Medicaid |
$4,597.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,643.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,961.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,865.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,010.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,689.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,763.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,025.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,673.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,143.96
|
| Rate for Payer: PHCS Commercial |
$12,832.91
|
| Rate for Payer: United Healthcare All Payer |
$11,763.50
|
|
|
MUCINEX D TAB SR 12H
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
NDC 63824005736
|
| Hospital Charge Code |
25001016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.56
|
| Rate for Payer: Humana Commercial |
$4.08
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.61
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
MUCINEX D TAB SR 12H
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
NDC 63824005736
|
| Hospital Charge Code |
25001016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.74
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.98
|
| Rate for Payer: First Health Commercial |
$4.56
|
| Rate for Payer: Humana Commercial |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.22
|
| Rate for Payer: Ohio Health Group HMO |
$3.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.61
|
| Rate for Payer: United Healthcare All Payer |
$4.22
|
|
|
MUCINEX (GUAIFENESIN) 600 MG T
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
25001015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
MUCINEX (GUAIFENESIN) 600 MG T
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 68084057201
|
| Hospital Charge Code |
25001015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
MUCOMYST 10% 400 MG/4 ML VLSYR
|
Facility
|
IP
|
$27.40
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
25002513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$26.30 |
| Rate for Payer: Aetna Commercial |
$21.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.37
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cigna Commercial |
$22.74
|
| Rate for Payer: First Health Commercial |
$26.03
|
| Rate for Payer: Humana Commercial |
$23.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.11
|
| Rate for Payer: Ohio Health Group HMO |
$20.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.49
|
| Rate for Payer: PHCS Commercial |
$26.30
|
| Rate for Payer: United Healthcare All Payer |
$24.11
|
|
|
MUCOMYST 10% 400 MG/4 ML VLSYR
|
Facility
|
OP
|
$27.40
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
25002513
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$26.30 |
| Rate for Payer: Aetna Commercial |
$21.10
|
| Rate for Payer: Anthem Medicaid |
$9.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.37
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cigna Commercial |
$22.74
|
| Rate for Payer: First Health Commercial |
$26.03
|
| Rate for Payer: Humana Commercial |
$23.29
|
| Rate for Payer: Humana KY Medicaid |
$9.42
|
| Rate for Payer: Kentucky WC Medicaid |
$9.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.11
|
| Rate for Payer: Ohio Health Group HMO |
$20.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.49
|
| Rate for Payer: PHCS Commercial |
$26.30
|
| Rate for Payer: United Healthcare All Payer |
$24.11
|
|
|
MUCOMYST 20% 6 GRAM(30ML)
|
Facility
|
OP
|
$64.01
|
|
|
Service Code
|
NDC 63323069030
|
| Hospital Charge Code |
25003234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$61.45 |
| Rate for Payer: Aetna Commercial |
$49.29
|
| Rate for Payer: Anthem Medicaid |
$22.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.93
|
| Rate for Payer: Cash Price |
$32.01
|
| Rate for Payer: Cigna Commercial |
$53.13
|
| Rate for Payer: First Health Commercial |
$60.81
|
| Rate for Payer: Humana Commercial |
$54.41
|
| Rate for Payer: Humana KY Medicaid |
$22.01
|
| Rate for Payer: Kentucky WC Medicaid |
$22.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.33
|
| Rate for Payer: Ohio Health Group HMO |
$48.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$61.45
|
| Rate for Payer: United Healthcare All Payer |
$56.33
|
|
|
MUCOMYST 20% 6 GRAM(30ML)
|
Facility
|
IP
|
$64.01
|
|
|
Service Code
|
NDC 63323069030
|
| Hospital Charge Code |
25003234
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$61.45 |
| Rate for Payer: Aetna Commercial |
$49.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.93
|
| Rate for Payer: Cash Price |
$32.01
|
| Rate for Payer: Cigna Commercial |
$53.13
|
| Rate for Payer: First Health Commercial |
$60.81
|
| Rate for Payer: Humana Commercial |
$54.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.33
|
| Rate for Payer: Ohio Health Group HMO |
$48.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$61.45
|
| Rate for Payer: United Healthcare All Payer |
$56.33
|
|
|
MUCOMYST 20%(ACETYLCY)ORAL 3ML
|
Facility
|
IP
|
$9.87
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
25001017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.70
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Cigna Commercial |
$8.19
|
| Rate for Payer: First Health Commercial |
$9.38
|
| Rate for Payer: Humana Commercial |
$8.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.69
|
| Rate for Payer: Ohio Health Group HMO |
$7.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$9.48
|
| Rate for Payer: United Healthcare All Payer |
$8.69
|
|
|
MUCOMYST 20%(ACETYLCY)ORAL 3ML
|
Facility
|
OP
|
$9.87
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
25001017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$9.48 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Anthem Medicaid |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.70
|
| Rate for Payer: Cash Price |
$4.93
|
| Rate for Payer: Cigna Commercial |
$8.19
|
| Rate for Payer: First Health Commercial |
$9.38
|
| Rate for Payer: Humana Commercial |
$8.39
|
| Rate for Payer: Humana KY Medicaid |
$3.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.69
|
| Rate for Payer: Ohio Health Group HMO |
$7.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$9.48
|
| Rate for Payer: United Healthcare All Payer |
$8.69
|
|
|
MUCOMYSTACETYLCYS20% 800MG/4ML
|
Facility
|
IP
|
$77.87
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
25002514
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$74.76 |
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.74
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cigna Commercial |
$64.63
|
| Rate for Payer: First Health Commercial |
$73.98
|
| Rate for Payer: Humana Commercial |
$66.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.53
|
| Rate for Payer: Ohio Health Group HMO |
$58.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.14
|
| Rate for Payer: PHCS Commercial |
$74.76
|
| Rate for Payer: United Healthcare All Payer |
$68.53
|
|
|
MUCOMYSTACETYLCYS20% 800MG/4ML
|
Facility
|
OP
|
$77.87
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
25002514
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$74.76 |
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Anthem Medicaid |
$26.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.74
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cigna Commercial |
$64.63
|
| Rate for Payer: First Health Commercial |
$73.98
|
| Rate for Payer: Humana Commercial |
$66.19
|
| Rate for Payer: Humana KY Medicaid |
$26.78
|
| Rate for Payer: Kentucky WC Medicaid |
$27.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.53
|
| Rate for Payer: Ohio Health Group HMO |
$58.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.14
|
| Rate for Payer: PHCS Commercial |
$74.76
|
| Rate for Payer: United Healthcare All Payer |
$68.53
|
|
|
MUGWORT IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000717
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
MUGWORT IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000717
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
MULTAQ 400MG TABLET
|
Facility
|
OP
|
$30.30
|
|
|
Service Code
|
NDC 24414260
|
| Hospital Charge Code |
25001018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$29.09 |
| Rate for Payer: Aetna Commercial |
$23.33
|
| Rate for Payer: Anthem Medicaid |
$10.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.63
|
| Rate for Payer: Cash Price |
$15.15
|
| Rate for Payer: Cigna Commercial |
$25.15
|
| Rate for Payer: First Health Commercial |
$28.78
|
| Rate for Payer: Humana Commercial |
$25.76
|
| Rate for Payer: Humana KY Medicaid |
$10.42
|
| Rate for Payer: Kentucky WC Medicaid |
$10.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.66
|
| Rate for Payer: Ohio Health Group HMO |
$22.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.39
|
| Rate for Payer: PHCS Commercial |
$29.09
|
| Rate for Payer: United Healthcare All Payer |
$26.66
|
|
|
MULTAQ 400MG TABLET
|
Facility
|
IP
|
$30.30
|
|
|
Service Code
|
NDC 24414260
|
| Hospital Charge Code |
25001018
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$29.09 |
| Rate for Payer: Aetna Commercial |
$23.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.63
|
| Rate for Payer: Cash Price |
$15.15
|
| Rate for Payer: Cigna Commercial |
$25.15
|
| Rate for Payer: First Health Commercial |
$28.78
|
| Rate for Payer: Humana Commercial |
$25.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.66
|
| Rate for Payer: Ohio Health Group HMO |
$22.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.39
|
| Rate for Payer: PHCS Commercial |
$29.09
|
| Rate for Payer: United Healthcare All Payer |
$26.66
|
|
|
MULTI-LINK 8LL STENT 3*33
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
