|
ONYX FRONTIER 4*38
|
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 4*38
|
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 4.5*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 4.5*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 4.5*15
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
ONYX FRONTIER 4.5*15
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
ONYX FRONTIER 4.5*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
|
|
|
ONYX FRONTIER 4.5*18
|
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 4.5*30
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
ONYX FRONTIER 4.5*30
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
ONYX FRONTIER 5.0*30
|
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 5.0*30
|
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
|
|
|
OPANA 10MG TABLET
|
Facility
|
OP
|
$60.35
|
|
|
Service Code
|
NDC 10702007106
|
| Hospital Charge Code |
25001131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$57.94 |
| Rate for Payer: Aetna Commercial |
$46.47
|
| Rate for Payer: Anthem Medicaid |
$20.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.07
|
| Rate for Payer: Cash Price |
$30.18
|
| Rate for Payer: Cigna Commercial |
$50.09
|
| Rate for Payer: First Health Commercial |
$57.33
|
| Rate for Payer: Humana Commercial |
$51.30
|
| Rate for Payer: Humana KY Medicaid |
$20.75
|
| Rate for Payer: Kentucky WC Medicaid |
$20.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.11
|
| Rate for Payer: Ohio Health Group HMO |
$45.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.71
|
| Rate for Payer: PHCS Commercial |
$57.94
|
| Rate for Payer: United Healthcare All Payer |
$53.11
|
|
|
OPANA 10MG TABLET
|
Facility
|
IP
|
$60.35
|
|
|
Service Code
|
NDC 10702007106
|
| Hospital Charge Code |
25001131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$57.94 |
| Rate for Payer: Aetna Commercial |
$46.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.07
|
| Rate for Payer: Cash Price |
$30.18
|
| Rate for Payer: Cigna Commercial |
$50.09
|
| Rate for Payer: First Health Commercial |
$57.33
|
| Rate for Payer: Humana Commercial |
$51.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.11
|
| Rate for Payer: Ohio Health Group HMO |
$45.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.71
|
| Rate for Payer: PHCS Commercial |
$57.94
|
| Rate for Payer: United Healthcare All Payer |
$53.11
|
|
|
OPANA ER 10MG TABLET
|
Facility
|
OP
|
$69.21
|
|
|
Service Code
|
NDC 64896069701
|
| Hospital Charge Code |
25003315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$66.44 |
| Rate for Payer: Anthem Medicaid |
$23.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.98
|
| Rate for Payer: Cash Price |
$34.60
|
| Rate for Payer: Cigna Commercial |
$57.44
|
| Rate for Payer: First Health Commercial |
$65.75
|
| Rate for Payer: Humana Commercial |
$58.83
|
| Rate for Payer: Humana KY Medicaid |
$23.80
|
| Rate for Payer: Kentucky WC Medicaid |
$24.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.90
|
| Rate for Payer: Ohio Health Group HMO |
$51.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.46
|
| Rate for Payer: PHCS Commercial |
$66.44
|
| Rate for Payer: United Healthcare All Payer |
$60.90
|
| Rate for Payer: Aetna Commercial |
$53.29
|
|
|
OPANA ER 10MG TABLET
|
Facility
|
IP
|
$69.21
|
|
|
Service Code
|
NDC 64896069701
|
| Hospital Charge Code |
25003315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$66.44 |
| Rate for Payer: Aetna Commercial |
$53.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.98
|
| Rate for Payer: Cash Price |
$34.60
|
| Rate for Payer: Cigna Commercial |
$57.44
|
| Rate for Payer: First Health Commercial |
$65.75
|
| Rate for Payer: Humana Commercial |
$58.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.90
|
| Rate for Payer: Ohio Health Group HMO |
$51.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.46
|
| Rate for Payer: PHCS Commercial |
$66.44
|
| Rate for Payer: United Healthcare All Payer |
$60.90
|
|
|
OP CARD REHAB W/O ECG MONITOR
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.80
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
OP CARD REHAB W/O ECG MONITOR
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem Medicaid |
$96.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$159.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.26
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Humana KY Medicaid |
$96.29
|
| Rate for Payer: Humana Medicare Advantage |
$114.27
|
| Rate for Payer: Kentucky WC Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.80
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
OPDIVO 240MG/24ML VIAL
|
Facility
|
OP
|
$41,608.79
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
25002665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$39,944.44 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,119.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,707.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,615.74
|
| Rate for Payer: Ohio Health Group HMO |
$31,206.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,321.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,409.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,898.72
|
| Rate for Payer: PHCS Commercial |
$39,944.44
|
| Rate for Payer: United Healthcare All Payer |
$36,615.74
|
| Rate for Payer: Aetna Commercial |
$32,038.77
|
| Rate for Payer: Anthem Medicaid |
$14,309.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$31.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,454.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$43.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.97
|
| Rate for Payer: Cash Price |
$20,804.40
|
| Rate for Payer: Cash Price |
$20,804.40
|
| Rate for Payer: Cigna Commercial |
$34,535.30
|
| Rate for Payer: First Health Commercial |
$39,528.35
|
| Rate for Payer: Humana Commercial |
$35,367.47
|
| Rate for Payer: Humana KY Medicaid |
$14,309.26
|
| Rate for Payer: Humana Medicare Advantage |
$31.09
|
| Rate for Payer: Kentucky WC Medicaid |
$14,454.89
|
|
|
OPDIVO 240MG/24ML VIAL
|
Facility
|
IP
|
$41,608.79
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
25002665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,409.14 |
| Max. Negotiated Rate |
$39,944.44 |
| Rate for Payer: Aetna Commercial |
$32,038.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,454.86
|
| Rate for Payer: Cash Price |
$20,804.40
|
| Rate for Payer: Cigna Commercial |
$34,535.30
|
| Rate for Payer: First Health Commercial |
$39,528.35
|
| Rate for Payer: Humana Commercial |
$35,367.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,119.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,707.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,482.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,615.74
|
| Rate for Payer: Ohio Health Group HMO |
$31,206.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,321.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,409.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,898.72
|
| Rate for Payer: PHCS Commercial |
$39,944.44
|
| Rate for Payer: United Healthcare All Payer |
$36,615.74
|
|
|
OPDIVO 40MG/4ML VIAL
|
Facility
|
OP
|
$6,934.80
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
25002666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$6,657.41 |
| Rate for Payer: Aetna Commercial |
$5,339.80
|
| Rate for Payer: Anthem Medicaid |
$2,384.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$31.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,409.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$43.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.97
|
| Rate for Payer: Cash Price |
$3,467.40
|
| Rate for Payer: Cash Price |
$3,467.40
|
| Rate for Payer: Cigna Commercial |
$5,755.88
|
| Rate for Payer: First Health Commercial |
$6,588.06
|
| Rate for Payer: Humana Commercial |
$5,894.58
|
| Rate for Payer: Humana KY Medicaid |
$2,384.88
|
| Rate for Payer: Humana Medicare Advantage |
$31.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,686.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,117.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,432.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,102.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,201.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$901.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,149.79
|
| Rate for Payer: PHCS Commercial |
$6,657.41
|
| Rate for Payer: United Healthcare All Payer |
$6,102.62
|
|
|
OPDIVO 40MG/4ML VIAL
|
Facility
|
IP
|
$6,934.80
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
25002666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$901.52 |
| Max. Negotiated Rate |
$6,657.41 |
| Rate for Payer: Aetna Commercial |
$5,339.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,409.14
|
| Rate for Payer: Cash Price |
$3,467.40
|
| Rate for Payer: Cigna Commercial |
$5,755.88
|
| Rate for Payer: First Health Commercial |
$6,588.06
|
| Rate for Payer: Humana Commercial |
$5,894.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,686.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,117.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,080.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,102.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,201.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,386.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$901.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,149.79
|
| Rate for Payer: PHCS Commercial |
$6,657.41
|
| Rate for Payer: United Healthcare All Payer |
$6,102.62
|
|
|
OPDUALAG 3/1mg(480/160mg/2SDV)
|
Facility
|
OP
|
$161,572.01
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
25004261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.15 |
| Max. Negotiated Rate |
$155,109.13 |
| Rate for Payer: Aetna Commercial |
$124,410.45
|
| Rate for Payer: Anthem Medicaid |
$55,564.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$187.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126,026.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$262.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$252.66
|
| Rate for Payer: Cash Price |
$80,786.01
|
| Rate for Payer: Cash Price |
$80,786.01
|
| Rate for Payer: Cigna Commercial |
$134,104.77
|
| Rate for Payer: First Health Commercial |
$153,493.41
|
| Rate for Payer: Humana Commercial |
$137,336.21
|
| Rate for Payer: Humana KY Medicaid |
$55,564.61
|
| Rate for Payer: Humana Medicare Advantage |
$187.15
|
| Rate for Payer: Kentucky WC Medicaid |
$56,130.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132,489.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119,240.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$56,679.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$142,183.37
|
| Rate for Payer: Ohio Health Group HMO |
$121,179.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,004.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,087.32
|
| Rate for Payer: PHCS Commercial |
$155,109.13
|
| Rate for Payer: United Healthcare All Payer |
$142,183.37
|
|
|
OPDUALAG 3/1mg(480/160mg/2SDV)
|
Facility
|
IP
|
$161,572.01
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
25004261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21,004.36 |
| Max. Negotiated Rate |
$155,109.13 |
| Rate for Payer: Aetna Commercial |
$124,410.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126,026.17
|
| Rate for Payer: Cash Price |
$80,786.01
|
| Rate for Payer: Cigna Commercial |
$134,104.77
|
| Rate for Payer: First Health Commercial |
$153,493.41
|
| Rate for Payer: Humana Commercial |
$137,336.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132,489.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119,240.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48,471.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$142,183.37
|
| Rate for Payer: Ohio Health Group HMO |
$121,179.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,314.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,004.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,087.32
|
| Rate for Payer: PHCS Commercial |
$155,109.13
|
| Rate for Payer: United Healthcare All Payer |
$142,183.37
|
|
|
OPEN AORTIC TUBE PROSTH REPR
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 34830
|
| Hospital Charge Code |
36001271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$714.00 |
| Max. Negotiated Rate |
$3,224.64 |
| Rate for Payer: Aetna Commercial |
$3,224.64
|
| Rate for Payer: Anthem Medicaid |
$1,378.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,040.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$3,083.04
|
| Rate for Payer: Healthspan PPO |
$3,170.45
|
| Rate for Payer: Humana Medicaid |
$1,378.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,477.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,406.25
|
| Rate for Payer: Molina Healthcare Passport |
$1,378.68
|
| Rate for Payer: Multiplan PHCS |
$1,224.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,428.00
|
| Rate for Payer: UHCCP Medicaid |
$714.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,392.47
|
|
