MOLINA EXCH - ALL OTHER PLANS: disclosed hospital rates

iDirect answer

Based on the published hospital price files, MOLINA EXCH - ALL OTHER PLANS appears in disclosed negotiated rates across 1 hospital and 86 services. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.

86 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
ALLODERM, PER SQUARE CENTIMETER Outpatient	Rush University Medical Center	27804116 CDM	$116	$58.04	$34.82 – $174	—
ANTERIOR CHAMBER INTRAOCULAR LENS Outpatient	Rush University Medical Center	27602630 CDM	$406	$203	$122 – $268	—
AUDITORY OSSEOINTEGRATED DEVICE, INCLUDES ALL INTERNAL AND EXTERNAL COMPONENTS Outpatient	Rush University Medical Center	27808690 CDM	$5,937	$2,968	$1,781 – $7,810	—
BATTERY, LITHIUM-ION, FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY Outpatient	Rush University Medical Center	27400506 CDM	$2,714	$1,357	$814 – $1,791	—
BCG LIVE INTRAVESICAL INSTILLATION, 1 MG Outpatient	Rush University Medical Center	1702010 CDM	$1,069	$535	$3.49 – $1,443	—
BRACHYTHERAPY PLANAR SOURCE, PALLADIUM-103, PER SQUARE MILLIMETER Outpatient	Rush University Medical Center	2780264500 CDM	$17.00	$8.50	$4.83 – $340	—
BRACHYTHERAPY SOURCE, NON-STRANDED, CESIUM-131, PER SOURCE Outpatient	Rush University Medical Center	2780264300 CDM	$93.00	$46.50	$27.90 – $4,490	—
BRACHYTHERAPY SOURCE, NON-STRANDED, HIGH ACTIVITY, IODINE-125, GREATER THAN 1.01 MCI (NIST), PER SOURCE Outpatient	Rush University Medical Center	2780263400 CDM	$1,151	$576	$179 – $4,490	—
BRACHYTHERAPY SOURCE, NON-STRANDED, HIGH DOSE RATE IRIDIUM-192, PER SOURCE Outpatient	Rush University Medical Center	2780171700 CDM	$405	$203	$122 – $547	—
BRACHYTHERAPY SOURCE, NON-STRANDED, IODINE-125, PER SOURCE Outpatient	Rush University Medical Center	2780263900 CDM	$1,468	$734	$37.74 – $1,982	—
BRACHYTHERAPY SOURCE, NON-STRANDED, YTTRIUM-90, PER SOURCE Outpatient	Rush University Medical Center	27802616 CDM	$64,996	$32,498	$7,150 – $87,744	—
BRACHYTHERAPY SOURCE, STRANDED, CESIUM-131, PER SOURCE Outpatient	Rush University Medical Center	27802642 CDM	$94,118	$47,059	$123 – $127,059	—
BRACHYTHERAPY SOURCE, STRANDED, IODINE-125, PER SOURCE Outpatient	Rush University Medical Center	2780263801 CDM	$1,469	$735	$36.32 – $1,983	—
COCHLEAR DEVICE, INCLUDES ALL INTERNAL AND EXTERNAL COMPONENTS Outpatient	Rush University Medical Center	27808614 CDM	$60,580	$30,290	$6,664 – $38,590	—
Complex drainage of wound infection after surgery Outpatient	Rush University Medical Center	2708006 CDM	$4,475	$2,238	$1,275 – $6,041	—
Correction of bunion Outpatient	Rush University Medical Center	2708385 CDM	$8,847	$4,424	$2,654 – $11,943	—
Correction of bunion with alignment correction of midfoot bone toward toe area Outpatient	Rush University Medical Center	2708386 CDM	$8,847	$4,424	$2,654 – $11,943	—
Correction of rigid deformity of first joint of big toe Outpatient	Rush University Medical Center	2708384 CDM	$8,847	$4,424	$2,654 – $11,943	—
Creation of opening to throat for feeding Outpatient	Rush University Medical Center	2700053 CDM	$4,225	$2,113	$1,268 – $5,704	—
DIRECT ADMISSION OF PATIENT FOR HOSPITAL OBSERVATION CARE Outpatient	Rush University Medical Center	1720022 CDM	$1,905	$953	$572 – $2,572	—
Evaluation of sleep-disordered breathing by examination of upper airway using an endoscope Outpatient	Rush University Medical Center	2700054 CDM	$1,678	$839	$213 – $2,594	—
GELATIN CAPSULES OR EQUIVALENT, FOR USE WITH TRACHEOESOPHAGEAL VOICE PROSTHESIS, REPLACEMENT ONLY, PER 10 Outpatient	Rush University Medical Center	2720851200 CDM	$12.00	$6.00	$2.63 – $7.92	—
GRADIENT COMPRESSION GARMENT, NECK/HEAD, EACH Outpatient	Rush University Medical Center	2700656600 CDM	$360	$180	$108 – $337	—
GRADIENT COMPRESSION GARMENT, NECK/HEAD, EACH Outpatient	Rush University Medical Center	2700656601 CDM	$162	$81.00	$48.60 – $337	—
GRAFTJACKET, PER SQUARE CENTIMETER Outpatient	Rush University Medical Center	27804107 CDM	$346	$173	$104 – $468	—