|
ONCOLOGY CARE MODEL SERVICE
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G9678
|
| Hospital Charge Code |
51000145
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Professional
|
Both
|
$4.10
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.10
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Healthspan PPO |
$0.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.14
|
| Rate for Payer: Multiplan PHCS |
$2.46
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.87
|
| Rate for Payer: UHCCP Medicaid |
$1.44
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Facility
|
OP
|
$63.14
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
25004038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$60.61 |
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Anthem Medicaid |
$21.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Cigna Commercial |
$52.41
|
| Rate for Payer: First Health Commercial |
$59.98
|
| Rate for Payer: Humana Commercial |
$53.67
|
| Rate for Payer: Humana KY Medicaid |
$21.71
|
| Rate for Payer: Kentucky WC Medicaid |
$21.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.56
|
| Rate for Payer: Ohio Health Group HMO |
$47.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.57
|
| Rate for Payer: PHCS Commercial |
$60.61
|
| Rate for Payer: United Healthcare All Payer |
$55.56
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Facility
|
IP
|
$4.10
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.90
|
| Rate for Payer: Humana Commercial |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.61
|
| Rate for Payer: Ohio Health Group HMO |
$3.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.27
|
| Rate for Payer: PHCS Commercial |
$3.94
|
| Rate for Payer: United Healthcare All Payer |
$3.61
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Facility
|
IP
|
$63.14
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
25004038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$60.61 |
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Cigna Commercial |
$52.41
|
| Rate for Payer: First Health Commercial |
$59.98
|
| Rate for Payer: Humana Commercial |
$53.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.56
|
| Rate for Payer: Ohio Health Group HMO |
$47.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.57
|
| Rate for Payer: PHCS Commercial |
$60.61
|
| Rate for Payer: United Healthcare All Payer |
$55.56
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Facility
|
OP
|
$4.10
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Anthem Medicaid |
$1.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.90
|
| Rate for Payer: Humana Commercial |
$3.48
|
| Rate for Payer: Humana KY Medicaid |
$1.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.61
|
| Rate for Payer: Ohio Health Group HMO |
$3.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.27
|
| Rate for Payer: PHCS Commercial |
$3.94
|
| Rate for Payer: United Healthcare All Payer |
$3.61
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Facility
|
OP
|
$4.10
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
636T0122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Anthem Medicaid |
$1.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.90
|
| Rate for Payer: Humana Commercial |
$3.48
|
| Rate for Payer: Humana KY Medicaid |
$1.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.61
|
| Rate for Payer: Ohio Health Group HMO |
$3.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.27
|
| Rate for Payer: PHCS Commercial |
$3.94
|
| Rate for Payer: United Healthcare All Payer |
$3.61
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Facility
|
IP
|
$4.10
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
636T0122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cigna Commercial |
$3.40
|
| Rate for Payer: First Health Commercial |
$3.90
|
| Rate for Payer: Humana Commercial |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.61
|
| Rate for Payer: Ohio Health Group HMO |
$3.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.27
|
| Rate for Payer: PHCS Commercial |
$3.94
|
| Rate for Payer: United Healthcare All Payer |
$3.61
|
|
|
ONE-WAY ALLOW PRORATED MILES
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS P9603
|
| Hospital Charge Code |
30001560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.83
|
| Rate for Payer: First Health Commercial |
$0.95
|
| Rate for Payer: Humana Commercial |
$0.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.88
|
| Rate for Payer: Ohio Health Group HMO |
$0.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.31
|
| Rate for Payer: PHCS Commercial |
$0.96
|
| Rate for Payer: United Healthcare All Payer |
$0.88
|
|
|
ONE-WAY ALLOW PRORATED MILES
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS P9603
|
| Hospital Charge Code |
30001560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.77
|
| Rate for Payer: Anthem Medicaid |
$0.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.83
|
| Rate for Payer: First Health Commercial |
$0.95
|
| Rate for Payer: Humana Commercial |
$0.85
|
| Rate for Payer: Humana KY Medicaid |
$0.34
|
| Rate for Payer: Kentucky WC Medicaid |
$0.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.88
|
| Rate for Payer: Ohio Health Group HMO |
$0.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.31
|
| Rate for Payer: PHCS Commercial |
$0.96
|
| Rate for Payer: United Healthcare All Payer |
$0.88
|
|
|
ONE-WAY ALLOW PRORATED TRIP
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS P9604
|
| Hospital Charge Code |
30001561
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Anthem Medicaid |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.03
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.30
|
| Rate for Payer: First Health Commercial |
$9.50
|
| Rate for Payer: Humana Commercial |
$8.50
|
| Rate for Payer: Humana KY Medicaid |
$3.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.80
|
| Rate for Payer: Ohio Health Group HMO |
$7.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Payer |
$8.80
|
|
|
ONE-WAY ALLOW PRORATED TRIP
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS P9604
|
| Hospital Charge Code |
30001561
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.03
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.30
|
| Rate for Payer: First Health Commercial |
$9.50
|
| Rate for Payer: Humana Commercial |
$8.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.80
|
| Rate for Payer: Ohio Health Group HMO |
$7.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Payer |
$8.80
|
|
|
ONIVYDE 1MG(43MG/10ML SDV)
|
Facility
|
IP
|
$15,450.75
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
25004487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,008.60 |
| Max. Negotiated Rate |
$14,832.72 |
| Rate for Payer: Aetna Commercial |
$11,897.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,051.58
|
| Rate for Payer: Cash Price |
$7,725.38
|
| Rate for Payer: Cigna Commercial |
$12,824.12
|
| Rate for Payer: First Health Commercial |
$14,678.21
|
| Rate for Payer: Humana Commercial |
$13,133.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,669.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,402.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,635.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,596.66
|
| Rate for Payer: Ohio Health Group HMO |
$11,588.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,090.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,008.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.73
|
| Rate for Payer: PHCS Commercial |
$14,832.72
|
| Rate for Payer: United Healthcare All Payer |
$13,596.66
|
|
|
ONIVYDE 1MG(43MG/10ML SDV)
|
Facility
|
OP
|
$15,450.75
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
25004487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.02 |
| Max. Negotiated Rate |
$14,832.72 |
| Rate for Payer: Aetna Commercial |
$11,897.08
|
| Rate for Payer: Anthem Medicaid |
$5,313.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,051.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$86.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$83.73
|
| Rate for Payer: Cash Price |
$7,725.38
|
| Rate for Payer: Cash Price |
$7,725.38
|
| Rate for Payer: Cigna Commercial |
$12,824.12
|
| Rate for Payer: First Health Commercial |
$14,678.21
|
| Rate for Payer: Humana Commercial |
$13,133.14
|
| Rate for Payer: Humana KY Medicaid |
$5,313.51
|
| Rate for Payer: Humana Medicare Advantage |
$62.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5,367.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,669.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,402.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,420.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,596.66
|
| Rate for Payer: Ohio Health Group HMO |
$11,588.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,090.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,008.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.73
|
| Rate for Payer: PHCS Commercial |
$14,832.72
|
| Rate for Payer: United Healthcare All Payer |
$13,596.66
|
|
|
ONTRUZANT 10MG(FROM 420MG MDV)
|
Facility
|
OP
|
$481.29
|
|
|
Service Code
|
HCPCS Q5112
|
| Hospital Charge Code |
25004022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.94 |
| Max. Negotiated Rate |
$462.04 |
| Rate for Payer: Aetna Commercial |
$370.59
|
| Rate for Payer: Anthem Medicaid |
$165.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.56
|
| Rate for Payer: Cash Price |
$240.65
|
| Rate for Payer: Cash Price |
$240.65
|
| Rate for Payer: Cigna Commercial |
$399.47
|
| Rate for Payer: First Health Commercial |
$457.23
|
| Rate for Payer: Humana Commercial |
$409.10
|
| Rate for Payer: Humana KY Medicaid |
$165.52
|
| Rate for Payer: Humana Medicare Advantage |
$38.94
|
| Rate for Payer: Kentucky WC Medicaid |
$167.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.54
|
| Rate for Payer: Ohio Health Group HMO |
$360.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.20
|
| Rate for Payer: PHCS Commercial |
$462.04
|
| Rate for Payer: United Healthcare All Payer |
$423.54
|
|
|
ONTRUZANT 10MG(FROM 420MG MDV)
|
Facility
|
IP
|
$481.29
|
|
|
Service Code
|
HCPCS Q5112
|
| Hospital Charge Code |
25004022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.57 |
| Max. Negotiated Rate |
$462.04 |
| Rate for Payer: Aetna Commercial |
$370.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.41
|
| Rate for Payer: Cash Price |
$240.65
|
| Rate for Payer: Cigna Commercial |
$399.47
|
| Rate for Payer: First Health Commercial |
$457.23
|
| Rate for Payer: Humana Commercial |
$409.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.54
|
| Rate for Payer: Ohio Health Group HMO |
$360.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.20
|
| Rate for Payer: PHCS Commercial |
$462.04
|
| Rate for Payer: United Healthcare All Payer |
$423.54
|
|
|
ONTRUZANT 150 MG/7.14 ML VIAL
|
Facility
|
OP
|
$7,219.40
|
|
|
Service Code
|
HCPCS Q5112
|
| Hospital Charge Code |
25003982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.94 |
| Max. Negotiated Rate |
$6,930.62 |
| Rate for Payer: Aetna Commercial |
$5,558.94
|
| Rate for Payer: Anthem Medicaid |
$2,482.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.56
|
| Rate for Payer: Cash Price |
$3,609.70
|
| Rate for Payer: Cash Price |
$3,609.70
|
| Rate for Payer: Cigna Commercial |
$5,992.10
|
| Rate for Payer: First Health Commercial |
$6,858.43
|
| Rate for Payer: Humana Commercial |
$6,136.49
|
| Rate for Payer: Humana KY Medicaid |
$2,482.75
|
| Rate for Payer: Humana Medicare Advantage |
$38.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,508.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,919.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,327.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,414.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.01
|
| Rate for Payer: PHCS Commercial |
$6,930.62
|
| Rate for Payer: United Healthcare All Payer |
$6,353.07
|
|
|
ONTRUZANT 150 MG/7.14 ML VIAL
|
Facility
|
IP
|
$7,219.40
|
|
|
Service Code
|
HCPCS Q5112
|
| Hospital Charge Code |
25003982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$938.52 |
| Max. Negotiated Rate |
$6,930.62 |
| Rate for Payer: Aetna Commercial |
$5,558.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.13
|
| Rate for Payer: Cash Price |
$3,609.70
|
| Rate for Payer: Cigna Commercial |
$5,992.10
|
| Rate for Payer: First Health Commercial |
$6,858.43
|
| Rate for Payer: Humana Commercial |
$6,136.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,919.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,327.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,414.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.01
|
| Rate for Payer: PHCS Commercial |
$6,930.62
|
| Rate for Payer: United Healthcare All Payer |
$6,353.07
|
|
|
ONYX FRONTIER 2.0*8
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem Medicaid |
$1,418.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Humana KY Medicaid |
$1,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
ONYX FRONTIER 2.0*8
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
ONYX FRONTIER 2.25*12
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem Medicaid |
$1,418.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Humana KY Medicaid |
$1,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
ONYX FRONTIER 2.25*12
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
ONYX FRONTIER 2.25*15
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
ONYX FRONTIER 2.25*15
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem Medicaid |
$1,418.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Humana KY Medicaid |
$1,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
ONYX FRONTIER 2.25*18
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
