|
O-F II ACET SHELL 64MM
|
Facility
|
OP
|
$7,306.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,191.88 |
| Max. Negotiated Rate |
$7,014.02 |
| Rate for Payer: Aetna Commercial |
$5,625.83
|
| Rate for Payer: Anthem Medicaid |
$2,512.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,698.89
|
| Rate for Payer: Cash Price |
$3,653.14
|
| Rate for Payer: Cigna Commercial |
$6,064.20
|
| Rate for Payer: First Health Commercial |
$6,940.96
|
| Rate for Payer: Humana Commercial |
$6,210.33
|
| Rate for Payer: Humana KY Medicaid |
$2,512.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,191.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,429.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,479.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,356.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.33
|
| Rate for Payer: PHCS Commercial |
$7,014.02
|
| Rate for Payer: United Healthcare All Payer |
$6,429.52
|
|
|
O-F II ACET SHELL 64MM
|
Facility
|
IP
|
$7,306.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,191.88 |
| Max. Negotiated Rate |
$7,014.02 |
| Rate for Payer: Aetna Commercial |
$5,625.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,698.89
|
| Rate for Payer: Cash Price |
$3,653.14
|
| Rate for Payer: Cigna Commercial |
$6,064.20
|
| Rate for Payer: First Health Commercial |
$6,940.96
|
| Rate for Payer: Humana Commercial |
$6,210.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,191.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,429.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,479.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,356.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.33
|
| Rate for Payer: PHCS Commercial |
$7,014.02
|
| Rate for Payer: United Healthcare All Payer |
$6,429.52
|
|
|
O-F II ACET SHELL 66MM
|
Facility
|
IP
|
$7,306.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,191.88 |
| Max. Negotiated Rate |
$7,014.02 |
| Rate for Payer: Aetna Commercial |
$5,625.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,698.89
|
| Rate for Payer: Cash Price |
$3,653.14
|
| Rate for Payer: Cigna Commercial |
$6,064.20
|
| Rate for Payer: First Health Commercial |
$6,940.96
|
| Rate for Payer: Humana Commercial |
$6,210.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,191.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,429.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,479.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,356.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.33
|
| Rate for Payer: PHCS Commercial |
$7,014.02
|
| Rate for Payer: United Healthcare All Payer |
$6,429.52
|
|
|
O-F II ACET SHELL 66MM
|
Facility
|
OP
|
$7,306.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,191.88 |
| Max. Negotiated Rate |
$7,014.02 |
| Rate for Payer: Aetna Commercial |
$5,625.83
|
| Rate for Payer: Anthem Medicaid |
$2,512.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,698.89
|
| Rate for Payer: Cash Price |
$3,653.14
|
| Rate for Payer: Cigna Commercial |
$6,064.20
|
| Rate for Payer: First Health Commercial |
$6,940.96
|
| Rate for Payer: Humana Commercial |
$6,210.33
|
| Rate for Payer: Humana KY Medicaid |
$2,512.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,191.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,429.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,479.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,356.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.33
|
| Rate for Payer: PHCS Commercial |
$7,014.02
|
| Rate for Payer: United Healthcare All Payer |
$6,429.52
|
|
|
O-F II ACET SHELL 68MM
|
Facility
|
IP
|
$7,306.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,191.88 |
| Max. Negotiated Rate |
$7,014.02 |
| Rate for Payer: Aetna Commercial |
$5,625.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,698.89
|
| Rate for Payer: Cash Price |
$3,653.14
|
| Rate for Payer: Cigna Commercial |
$6,064.20
|
| Rate for Payer: First Health Commercial |
$6,940.96
|
| Rate for Payer: Humana Commercial |
$6,210.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,191.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,429.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,479.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,356.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.33
|
| Rate for Payer: PHCS Commercial |
$7,014.02
|
| Rate for Payer: United Healthcare All Payer |
$6,429.52
|
|
|
O-F II ACET SHELL 68MM
|
Facility
|
OP
|
$7,306.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,191.88 |
| Max. Negotiated Rate |
$7,014.02 |
| Rate for Payer: Aetna Commercial |
$5,625.83
|
| Rate for Payer: Anthem Medicaid |
$2,512.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,698.89
|
| Rate for Payer: Cash Price |
$3,653.14
|
| Rate for Payer: Cigna Commercial |
$6,064.20
|
| Rate for Payer: First Health Commercial |
$6,940.96
|
| Rate for Payer: Humana Commercial |
$6,210.33
|
| Rate for Payer: Humana KY Medicaid |
$2,512.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,191.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,429.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,479.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,356.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.33
|
| Rate for Payer: PHCS Commercial |
$7,014.02
|
| Rate for Payer: United Healthcare All Payer |
$6,429.52
|
|
|
O-F II ACET SHELL 70MM
|
Facility
|
OP
|
$7,306.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,191.88 |
| Max. Negotiated Rate |
$7,014.02 |
| Rate for Payer: Aetna Commercial |
$5,625.83
|
| Rate for Payer: Anthem Medicaid |
$2,512.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,698.89
|
| Rate for Payer: Cash Price |
$3,653.14
|
| Rate for Payer: Cigna Commercial |
$6,064.20
|
| Rate for Payer: First Health Commercial |
$6,940.96
|
| Rate for Payer: Humana Commercial |
$6,210.33
|
| Rate for Payer: Humana KY Medicaid |
$2,512.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,191.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,429.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,479.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,356.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.33
|
| Rate for Payer: PHCS Commercial |
$7,014.02
|
| Rate for Payer: United Healthcare All Payer |
$6,429.52
|
|
|
O-F II ACET SHELL 70MM
|
Facility
|
IP
|
$7,306.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,191.88 |
| Max. Negotiated Rate |
$7,014.02 |
| Rate for Payer: Aetna Commercial |
$5,625.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,698.89
|
| Rate for Payer: Cash Price |
$3,653.14
|
| Rate for Payer: Cigna Commercial |
$6,064.20
|
| Rate for Payer: First Health Commercial |
$6,940.96
|
| Rate for Payer: Humana Commercial |
$6,210.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,991.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,191.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,429.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,479.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,356.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,041.33
|
| Rate for Payer: PHCS Commercial |
$7,014.02
|
| Rate for Payer: United Healthcare All Payer |
$6,429.52
|
|
|
OFLOXACIN 0.5% EYE DROPS 5ML
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
25003311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Aetna Commercial |
$0.69
|
| Rate for Payer: Anthem Medicaid |
$0.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.70
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna Commercial |
$0.75
|
| Rate for Payer: First Health Commercial |
$0.86
|
| Rate for Payer: Humana Commercial |
$0.77
|
| Rate for Payer: Humana KY Medicaid |
$0.31
|
| Rate for Payer: Kentucky WC Medicaid |
$0.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.79
|
| Rate for Payer: Ohio Health Group HMO |
$0.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.62
|
| Rate for Payer: PHCS Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Payer |
$0.79
|
|
|
OFLOXACIN 0.5% EYE DROPS 5ML
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
25003311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.86 |
| Rate for Payer: Aetna Commercial |
$0.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.70
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna Commercial |
$0.75
|
| Rate for Payer: First Health Commercial |
$0.86
|
| Rate for Payer: Humana Commercial |
$0.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.79
|
| Rate for Payer: Ohio Health Group HMO |
$0.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.62
|
| Rate for Payer: PHCS Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Payer |
$0.79
|
|
|
OGIVRI 10mg (150mg SDV)
|
Facility
|
IP
|
$5,125.78
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
25004110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,537.73 |
| Max. Negotiated Rate |
$4,920.75 |
| Rate for Payer: Aetna Commercial |
$3,946.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.11
|
| Rate for Payer: Cash Price |
$2,562.89
|
| Rate for Payer: Cigna Commercial |
$4,254.40
|
| Rate for Payer: First Health Commercial |
$4,869.49
|
| Rate for Payer: Humana Commercial |
$4,356.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,782.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,510.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,100.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,459.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,536.79
|
| Rate for Payer: PHCS Commercial |
$4,920.75
|
| Rate for Payer: United Healthcare All Payer |
$4,510.69
|
|
|
OGIVRI 10mg (150mg SDV)
|
Facility
|
OP
|
$5,125.78
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
25004110
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.59 |
| Max. Negotiated Rate |
$4,920.75 |
| Rate for Payer: Aetna Commercial |
$3,946.85
|
| Rate for Payer: Anthem Medicaid |
$1,762.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$44.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$62.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.20
|
| Rate for Payer: Cash Price |
$2,562.89
|
| Rate for Payer: Cash Price |
$2,562.89
|
| Rate for Payer: Cigna Commercial |
$4,254.40
|
| Rate for Payer: First Health Commercial |
$4,869.49
|
| Rate for Payer: Humana Commercial |
$4,356.91
|
| Rate for Payer: Humana KY Medicaid |
$1,762.76
|
| Rate for Payer: Humana Medicare Advantage |
$44.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,782.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,510.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,100.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,459.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,536.79
|
| Rate for Payer: PHCS Commercial |
$4,920.75
|
| Rate for Payer: United Healthcare All Payer |
$4,510.69
|
|
|
OGIVRI 10mg (from 420mg MDV)
|
Facility
|
OP
|
$340.63
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
25004111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.59 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Aetna Commercial |
$262.29
|
| Rate for Payer: Anthem Medicaid |
$117.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$44.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$62.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.20
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cigna Commercial |
$282.72
|
| Rate for Payer: First Health Commercial |
$323.60
|
| Rate for Payer: Humana Commercial |
$289.54
|
| Rate for Payer: Humana KY Medicaid |
$117.14
|
| Rate for Payer: Humana Medicare Advantage |
$44.59
|
| Rate for Payer: Kentucky WC Medicaid |
$118.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.75
|
| Rate for Payer: Ohio Health Group HMO |
$255.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.03
|
| Rate for Payer: PHCS Commercial |
$327.00
|
| Rate for Payer: United Healthcare All Payer |
$299.75
|
|
|
OGIVRI 10mg (from 420mg MDV)
|
Facility
|
IP
|
$340.63
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
25004111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.19 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Aetna Commercial |
$262.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.69
|
| Rate for Payer: Cash Price |
$170.32
|
| Rate for Payer: Cigna Commercial |
$282.72
|
| Rate for Payer: First Health Commercial |
$323.60
|
| Rate for Payer: Humana Commercial |
$289.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.75
|
| Rate for Payer: Ohio Health Group HMO |
$255.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.03
|
| Rate for Payer: PHCS Commercial |
$327.00
|
| Rate for Payer: United Healthcare All Payer |
$299.75
|
|
|
OLANZAPINE 0.5mg (10mg SDV)
|
Facility
|
IP
|
$184.07
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
25003646
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.22 |
| Max. Negotiated Rate |
$176.71 |
| Rate for Payer: Aetna Commercial |
$141.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.57
|
| Rate for Payer: Cash Price |
$92.03
|
| Rate for Payer: Cigna Commercial |
$152.78
|
| Rate for Payer: First Health Commercial |
$174.87
|
| Rate for Payer: Humana Commercial |
$156.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.98
|
| Rate for Payer: Ohio Health Group HMO |
$138.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.01
|
| Rate for Payer: PHCS Commercial |
$176.71
|
| Rate for Payer: United Healthcare All Payer |
$161.98
|
|
|
OLANZAPINE 0.5mg (10mg SDV)
|
Facility
|
OP
|
$184.07
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
25003646
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.22 |
| Max. Negotiated Rate |
$176.71 |
| Rate for Payer: Aetna Commercial |
$141.73
|
| Rate for Payer: Anthem Medicaid |
$63.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.57
|
| Rate for Payer: Cash Price |
$92.03
|
| Rate for Payer: Cigna Commercial |
$152.78
|
| Rate for Payer: First Health Commercial |
$174.87
|
| Rate for Payer: Humana Commercial |
$156.46
|
| Rate for Payer: Humana KY Medicaid |
$63.30
|
| Rate for Payer: Kentucky WC Medicaid |
$63.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.98
|
| Rate for Payer: Ohio Health Group HMO |
$138.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.01
|
| Rate for Payer: PHCS Commercial |
$176.71
|
| Rate for Payer: United Healthcare All Payer |
$161.98
|
|
|
OLD DIG E/M SVC 11-20
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 99422
|
| Hospital Charge Code |
51000305
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.38 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Ambetter Exchange |
$23.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.38
|
| Rate for Payer: Anthem Medicaid |
$23.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.79
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Humana Medicaid |
$23.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.35
|
| Rate for Payer: Molina Healthcare Passport |
$23.87
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.19
|
| Rate for Payer: UHCCP Medicaid |
$22.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.99
|
|
|
OL DIG E/M SVC 21+ MIN
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 99423
|
| Hospital Charge Code |
51000306
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Ambetter Exchange |
$37.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.06
|
| Rate for Payer: Anthem Medicaid |
$38.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.68
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Humana Medicaid |
$38.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.33
|
| Rate for Payer: Molina Healthcare Passport |
$38.56
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.40
|
| Rate for Payer: UHCCP Medicaid |
$35.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.23
|
|
|
OL DIG E/M SVC 5-10 MIN
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 99421
|
| Hospital Charge Code |
51000304
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$72.96 |
| Rate for Payer: Ambetter Exchange |
$12.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$10.41
|
| Rate for Payer: Anthem Medicaid |
$11.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.40
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Humana Medicaid |
$11.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.18
|
| Rate for Payer: Molina Healthcare Passport |
$11.94
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$15.60
|
| Rate for Payer: UHCCP Medicaid |
$10.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.00
|
|
|
OLIVE WIRE
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
OLIVE WIRE
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
OLIVE WIRE SMOOTH 1.3
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.90 |
| Max. Negotiated Rate |
$1,462.08 |
| Rate for Payer: Aetna Commercial |
$1,172.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.94
|
| Rate for Payer: Cash Price |
$761.50
|
| Rate for Payer: Cigna Commercial |
$1,264.09
|
| Rate for Payer: First Health Commercial |
$1,446.85
|
| Rate for Payer: Humana Commercial |
$1,294.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,325.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.87
|
| Rate for Payer: PHCS Commercial |
$1,462.08
|
| Rate for Payer: United Healthcare All Payer |
$1,340.24
|
|
|
OLIVE WIRE SMOOTH 1.3
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.90 |
| Max. Negotiated Rate |
$1,462.08 |
| Rate for Payer: Aetna Commercial |
$1,172.71
|
| Rate for Payer: Anthem Medicaid |
$523.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.94
|
| Rate for Payer: Cash Price |
$761.50
|
| Rate for Payer: Cigna Commercial |
$1,264.09
|
| Rate for Payer: First Health Commercial |
$1,446.85
|
| Rate for Payer: Humana Commercial |
$1,294.55
|
| Rate for Payer: Humana KY Medicaid |
$523.76
|
| Rate for Payer: Kentucky WC Medicaid |
$529.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,325.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.87
|
| Rate for Payer: PHCS Commercial |
$1,462.08
|
| Rate for Payer: United Healthcare All Payer |
$1,340.24
|
|
|
OLUMIANT 1 MG TABLET
|
Facility
|
IP
|
$164.25
|
|
|
Service Code
|
NDC 2473230
|
| Hospital Charge Code |
25004136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$157.68 |
| Rate for Payer: Aetna Commercial |
$126.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.12
|
| Rate for Payer: Cash Price |
$82.12
|
| Rate for Payer: Cigna Commercial |
$136.33
|
| Rate for Payer: First Health Commercial |
$156.04
|
| Rate for Payer: Humana Commercial |
$139.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.54
|
| Rate for Payer: Ohio Health Group HMO |
$123.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.33
|
| Rate for Payer: PHCS Commercial |
$157.68
|
| Rate for Payer: United Healthcare All Payer |
$144.54
|
|
|
OLUMIANT 1 MG TABLET
|
Facility
|
OP
|
$164.25
|
|
|
Service Code
|
NDC 2473230
|
| Hospital Charge Code |
25004136
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$157.68 |
| Rate for Payer: Aetna Commercial |
$126.47
|
| Rate for Payer: Anthem Medicaid |
$56.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.12
|
| Rate for Payer: Cash Price |
$82.12
|
| Rate for Payer: Cigna Commercial |
$136.33
|
| Rate for Payer: First Health Commercial |
$156.04
|
| Rate for Payer: Humana Commercial |
$139.61
|
| Rate for Payer: Humana KY Medicaid |
$56.49
|
| Rate for Payer: Kentucky WC Medicaid |
$57.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.54
|
| Rate for Payer: Ohio Health Group HMO |
$123.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.33
|
| Rate for Payer: PHCS Commercial |
$157.68
|
| Rate for Payer: United Healthcare All Payer |
$144.54
|
|
