|
OCTAGAM 5% 500mg (2.5gm) SDV
|
Facility
|
OP
|
$2,646.68
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
25003840
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$2,540.81 |
| Rate for Payer: Aetna Commercial |
$2,037.94
|
| Rate for Payer: Anthem Medicaid |
$910.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$44.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,064.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$62.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.72
|
| Rate for Payer: Cash Price |
$1,323.34
|
| Rate for Payer: Cash Price |
$1,323.34
|
| Rate for Payer: Cigna Commercial |
$2,196.74
|
| Rate for Payer: First Health Commercial |
$2,514.35
|
| Rate for Payer: Humana Commercial |
$2,249.68
|
| Rate for Payer: Humana KY Medicaid |
$910.19
|
| Rate for Payer: Humana Medicare Advantage |
$44.98
|
| Rate for Payer: Kentucky WC Medicaid |
$919.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,170.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,953.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$928.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,329.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,985.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$344.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$820.47
|
| Rate for Payer: PHCS Commercial |
$2,540.81
|
| Rate for Payer: United Healthcare All Payer |
$2,329.08
|
|
|
OCTAGAM 5% 500mg (5gm) SDV
|
Facility
|
IP
|
$5,293.31
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
25003832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$688.13 |
| Max. Negotiated Rate |
$5,081.58 |
| Rate for Payer: Aetna Commercial |
$4,075.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,128.78
|
| Rate for Payer: Cash Price |
$2,646.66
|
| Rate for Payer: Cigna Commercial |
$4,393.45
|
| Rate for Payer: First Health Commercial |
$5,028.64
|
| Rate for Payer: Humana Commercial |
$4,499.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,340.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,906.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,587.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,658.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,969.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,058.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$688.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,640.93
|
| Rate for Payer: PHCS Commercial |
$5,081.58
|
| Rate for Payer: United Healthcare All Payer |
$4,658.11
|
|
|
OCTAGAM 5% 500mg (5gm) SDV
|
Facility
|
OP
|
$5,293.31
|
|
|
Service Code
|
HCPCS J1568
|
| Hospital Charge Code |
25003832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$5,081.58 |
| Rate for Payer: Aetna Commercial |
$4,075.85
|
| Rate for Payer: Anthem Medicaid |
$1,820.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$44.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,128.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$62.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.72
|
| Rate for Payer: Cash Price |
$2,646.66
|
| Rate for Payer: Cash Price |
$2,646.66
|
| Rate for Payer: Cigna Commercial |
$4,393.45
|
| Rate for Payer: First Health Commercial |
$5,028.64
|
| Rate for Payer: Humana Commercial |
$4,499.31
|
| Rate for Payer: Humana KY Medicaid |
$1,820.37
|
| Rate for Payer: Humana Medicare Advantage |
$44.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,838.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,340.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,906.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,856.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,658.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,969.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,058.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$688.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,640.93
|
| Rate for Payer: PHCS Commercial |
$5,081.58
|
| Rate for Payer: United Healthcare All Payer |
$4,658.11
|
|
|
OCTREOTIDE 50mcg/mL AMPUL IV a
|
Facility
|
IP
|
$121.12
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
25004019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$116.28 |
| Rate for Payer: Aetna Commercial |
$93.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.47
|
| Rate for Payer: Cash Price |
$60.56
|
| Rate for Payer: Cigna Commercial |
$100.53
|
| Rate for Payer: First Health Commercial |
$115.06
|
| Rate for Payer: Humana Commercial |
$102.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.59
|
| Rate for Payer: Ohio Health Group HMO |
$90.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.55
|
| Rate for Payer: PHCS Commercial |
$116.28
|
| Rate for Payer: United Healthcare All Payer |
$106.59
|
|
|
OCTREOTIDE 50mcg/mL AMPUL IV a
|
Facility
|
OP
|
$121.12
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
25004019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$116.28 |
| Rate for Payer: Aetna Commercial |
$93.26
|
| Rate for Payer: Anthem Medicaid |
$41.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.47
|
| Rate for Payer: Cash Price |
$60.56
|
| Rate for Payer: Cigna Commercial |
$100.53
|
| Rate for Payer: First Health Commercial |
$115.06
|
| Rate for Payer: Humana Commercial |
$102.95
|
| Rate for Payer: Humana KY Medicaid |
$41.65
|
| Rate for Payer: Kentucky WC Medicaid |
$42.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.59
|
| Rate for Payer: Ohio Health Group HMO |
$90.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.55
|
| Rate for Payer: PHCS Commercial |
$116.28
|
| Rate for Payer: United Healthcare All Payer |
$106.59
|
|
|
OCTREOTIDE 50mcg/mL AMPUL SubQ
|
Facility
|
OP
|
$121.12
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
25004018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$116.28 |
| Rate for Payer: Aetna Commercial |
$93.26
|
| Rate for Payer: Anthem Medicaid |
$41.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.47
|
| Rate for Payer: Cash Price |
$60.56
|
| Rate for Payer: Cigna Commercial |
$100.53
|
| Rate for Payer: First Health Commercial |
$115.06
|
| Rate for Payer: Humana Commercial |
$102.95
|
| Rate for Payer: Humana KY Medicaid |
$41.65
|
| Rate for Payer: Kentucky WC Medicaid |
$42.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.59
|
| Rate for Payer: Ohio Health Group HMO |
$90.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.55
|
| Rate for Payer: PHCS Commercial |
$116.28
|
| Rate for Payer: United Healthcare All Payer |
$106.59
|
|
|
OCTREOTIDE 50mcg/mL AMPUL SubQ
|
Facility
|
IP
|
$121.12
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
25004018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$116.28 |
| Rate for Payer: Aetna Commercial |
$93.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$94.47
|
| Rate for Payer: Cash Price |
$60.56
|
| Rate for Payer: Cigna Commercial |
$100.53
|
| Rate for Payer: First Health Commercial |
$115.06
|
| Rate for Payer: Humana Commercial |
$102.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$99.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$89.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$106.59
|
| Rate for Payer: Ohio Health Group HMO |
$90.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.55
|
| Rate for Payer: PHCS Commercial |
$116.28
|
| Rate for Payer: United Healthcare All Payer |
$106.59
|
|
|
OCUFEN (FLURBIPROFEN).03 2.5ML
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
NDC 69292072225
|
| Hospital Charge Code |
25001118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.72
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: First Health Commercial |
$70.30
|
| Rate for Payer: Humana Commercial |
$62.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.94
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
OCUFEN (FLURBIPROFEN).03 2.5ML
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
NDC 69292072225
|
| Hospital Charge Code |
25001118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.72
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: First Health Commercial |
$70.30
|
| Rate for Payer: Humana Commercial |
$62.90
|
| Rate for Payer: Humana KY Medicaid |
$25.45
|
| Rate for Payer: Kentucky WC Medicaid |
$25.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.94
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
OCULAR IMP - AQUEOUS DRAIN DE
|
Facility
|
IP
|
$10,656.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,385.28 |
| Max. Negotiated Rate |
$10,229.76 |
| Rate for Payer: Aetna Commercial |
$8,205.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,311.68
|
| Rate for Payer: Cash Price |
$5,328.00
|
| Rate for Payer: Cigna Commercial |
$8,844.48
|
| Rate for Payer: First Health Commercial |
$10,123.20
|
| Rate for Payer: Humana Commercial |
$9,057.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,737.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,864.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,196.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,377.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,992.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,385.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,303.36
|
| Rate for Payer: PHCS Commercial |
$10,229.76
|
| Rate for Payer: United Healthcare All Payer |
$9,377.28
|
|
|
OCULAR IMP - AQUEOUS DRAIN DE
|
Facility
|
OP
|
$10,656.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
27000084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,385.28 |
| Max. Negotiated Rate |
$10,229.76 |
| Rate for Payer: Aetna Commercial |
$8,205.12
|
| Rate for Payer: Anthem Medicaid |
$3,664.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,311.68
|
| Rate for Payer: Cash Price |
$5,328.00
|
| Rate for Payer: Cigna Commercial |
$8,844.48
|
| Rate for Payer: First Health Commercial |
$10,123.20
|
| Rate for Payer: Humana Commercial |
$9,057.60
|
| Rate for Payer: Humana KY Medicaid |
$3,664.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,701.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,737.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,864.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,196.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,738.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,377.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,992.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,131.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,385.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,303.36
|
| Rate for Payer: PHCS Commercial |
$10,229.76
|
| Rate for Payer: United Healthcare All Payer |
$9,377.28
|
|
|
OCULAR INSTRUMNT SCREEN BIL
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 99177
|
| Hospital Charge Code |
51000354
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.14
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.03
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
|
OCULAR INSTRUMNT SCREEN BIL
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 99177
|
| Hospital Charge Code |
51000354
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$4.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.14
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Humana KY Medicaid |
$4.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.03
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
|
OCULAR INSTRUMNT SCREEN BIL
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 99177
|
| Hospital Charge Code |
51000354
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$4.84
|
| Rate for Payer: Anthem Medicaid |
$3.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.00
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Humana Medicaid |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3.71
|
| Rate for Payer: Molina Healthcare Passport |
$3.64
|
| Rate for Payer: Multiplan PHCS |
$7.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.10
|
| Rate for Payer: UHCCP Medicaid |
$5.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.68
|
|
|
OCUPRESS(CARTEOLOL) 1% OP 5ML
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 61314023805
|
| Hospital Charge Code |
25001119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna Commercial |
$0.68
|
| Rate for Payer: Anthem Medicaid |
$0.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna Commercial |
$0.73
|
| Rate for Payer: First Health Commercial |
$0.84
|
| Rate for Payer: Humana Commercial |
$0.75
|
| Rate for Payer: Humana KY Medicaid |
$0.30
|
| Rate for Payer: Kentucky WC Medicaid |
$0.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.77
|
| Rate for Payer: Ohio Health Group HMO |
$0.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.27
|
| Rate for Payer: PHCS Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Payer |
$0.77
|
|
|
OCUPRESS(CARTEOLOL) 1% OP 5ML
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 61314023805
|
| Hospital Charge Code |
25001119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna Commercial |
$0.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna Commercial |
$0.73
|
| Rate for Payer: First Health Commercial |
$0.84
|
| Rate for Payer: Humana Commercial |
$0.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.77
|
| Rate for Payer: Ohio Health Group HMO |
$0.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.27
|
| Rate for Payer: PHCS Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Payer |
$0.77
|
|
|
OCU ROOM RATE
|
Facility
|
IP
|
$1,679.00
|
|
| Hospital Charge Code |
11000008
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$218.27 |
| Max. Negotiated Rate |
$1,611.84 |
| Rate for Payer: Aetna Commercial |
$1,292.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,309.62
|
| Rate for Payer: Cash Price |
$839.50
|
| Rate for Payer: Cigna Commercial |
$1,393.57
|
| Rate for Payer: First Health Commercial |
$1,595.05
|
| Rate for Payer: Humana Commercial |
$1,427.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,376.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,477.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,259.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.49
|
| Rate for Payer: PHCS Commercial |
$1,611.84
|
| Rate for Payer: United Healthcare All Payer |
$1,477.52
|
|
|
OFFICE CONSULT - COSMETIC
|
Professional
|
Both
|
$100.00
|
|
| Hospital Charge Code |
22200031
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
|
|
OFF/OP CNSLTJ NEW/EST LOW 30
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
51000330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$154.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.76
|
| Rate for Payer: Anthem Medicaid |
$76.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$184.90
|
| Rate for Payer: Healthspan PPO |
$145.25
|
| Rate for Payer: Humana Medicaid |
$76.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$129.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.06
|
| Rate for Payer: Molina Healthcare Passport |
$76.53
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$217.00
|
| Rate for Payer: UHCCP Medicaid |
$50.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.30
|
|
|
OFF/OP CNSLTJ NEW/EST LOW 30
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
51000330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.10
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
OFF/OP CNSLTJ NEW/EST LOW 30
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
51000330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem Medicaid |
$106.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Humana KY Medicaid |
$106.61
|
| Rate for Payer: Kentucky WC Medicaid |
$107.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.10
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
OFF/OP CNSLTJ NEW/EST LOW 30(P
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
510P0330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$184.90 |
| Rate for Payer: Aetna Commercial |
$154.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.76
|
| Rate for Payer: Anthem Medicaid |
$76.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$184.90
|
| Rate for Payer: Healthspan PPO |
$145.25
|
| Rate for Payer: Humana Medicaid |
$76.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$129.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.06
|
| Rate for Payer: Molina Healthcare Passport |
$76.53
|
| Rate for Payer: Multiplan PHCS |
$81.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.50
|
| Rate for Payer: UHCCP Medicaid |
$50.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.30
|
|
|
OFF/OP CNSLTJ NEW/EST LOW 30(T
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
510T0330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
OFF/OP CNSLTJ NEW/EST LOW 30(T
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
510T0330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
51000331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Anthem Medicaid |
$116.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.20
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$323.00
|
| Rate for Payer: Humana Commercial |
$289.00
|
| Rate for Payer: Humana KY Medicaid |
$116.93
|
| Rate for Payer: Kentucky WC Medicaid |
$118.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.20
|
| Rate for Payer: Ohio Health Group HMO |
$255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.40
|
| Rate for Payer: PHCS Commercial |
$326.40
|
| Rate for Payer: United Healthcare All Payer |
$299.20
|
|
