|
OMENTECTOMY(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49255
|
| Hospital Charge Code |
761P1986
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.89 |
| Max. Negotiated Rate |
$1,126.51 |
| Rate for Payer: Aetna Commercial |
$1,126.51
|
| Rate for Payer: Ambetter Exchange |
$755.37
|
| Rate for Payer: Anthem Medicaid |
$284.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$755.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$755.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$906.44
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,049.27
|
| Rate for Payer: Healthspan PPO |
$950.01
|
| Rate for Payer: Humana Medicaid |
$284.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,001.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$755.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$755.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$290.59
|
| Rate for Payer: Molina Healthcare Passport |
$284.89
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$981.98
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$755.37
|
|
|
OMM 5-6 BODY REGIONS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
76102508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.38 |
| 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 |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| 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 |
$23.38
|
| 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 |
$28.06
|
| 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 |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
OMM 5-6 BODY REGIONS
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
45000316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$48.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Humana KY Medicaid |
$48.15
|
| Rate for Payer: Humana Medicare Advantage |
$23.38
|
| Rate for Payer: Kentucky WC Medicaid |
$48.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OMM 5-6 BODY REGIONS
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
76102508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$42.74
|
| Rate for Payer: Ambetter Exchange |
$43.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.53
|
| Rate for Payer: Anthem Medicaid |
$36.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$68.27
|
| Rate for Payer: Humana Medicaid |
$36.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.18
|
| Rate for Payer: Molina Healthcare Passport |
$36.45
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.33
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.33
|
|
|
OMM 5-6 BODY REGIONS
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
45000316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.20
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OMM 5-6 BODY REGIONS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
76102508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.00 |
| 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 |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
OMM 5-6 BODY REGIONS(P
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
761P2508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$42.74
|
| Rate for Payer: Ambetter Exchange |
$43.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.53
|
| Rate for Payer: Anthem Medicaid |
$36.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$68.27
|
| Rate for Payer: Humana Medicaid |
$36.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.18
|
| Rate for Payer: Molina Healthcare Passport |
$36.45
|
| Rate for Payer: Multiplan PHCS |
$84.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.33
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.33
|
|
|
OMM 5-6 BODY REGIONS(T
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
761T2508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$48.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Humana KY Medicaid |
$48.15
|
| Rate for Payer: Humana Medicare Advantage |
$23.38
|
| Rate for Payer: Kentucky WC Medicaid |
$48.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OMM 5-6 BODY REGIONS(T
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
761T2508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.20
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OMM 7-8 BODY REGIONS
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
76102509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Humana KY Medicaid |
$19.26
|
| Rate for Payer: Humana Medicare Advantage |
$23.38
|
| Rate for Payer: Kentucky WC Medicaid |
$19.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.64
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
OMM 7-8 BODY REGIONS
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
45000317
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Humana KY Medicaid |
$19.26
|
| Rate for Payer: Humana Medicare Advantage |
$23.38
|
| Rate for Payer: Kentucky WC Medicaid |
$19.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.64
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
OMM 7-8 BODY REGIONS
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
76102509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$80.89 |
| Rate for Payer: Aetna Commercial |
$50.59
|
| Rate for Payer: Ambetter Exchange |
$54.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$42.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.64
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$80.89
|
| Rate for Payer: Humana Medicaid |
$42.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.31
|
| Rate for Payer: Molina Healthcare Passport |
$42.46
|
| Rate for Payer: Multiplan PHCS |
$33.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.11
|
| Rate for Payer: UHCCP Medicaid |
$31.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.70
|
|
|
OMM 7-8 BODY REGIONS
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
76102509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.68
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.64
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
OMM 7-8 BODY REGIONS
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
45000317
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$53.76 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.68
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna Commercial |
$46.48
|
| Rate for Payer: First Health Commercial |
$53.20
|
| Rate for Payer: Humana Commercial |
$47.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.28
|
| Rate for Payer: Ohio Health Group HMO |
$42.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.64
|
| Rate for Payer: PHCS Commercial |
$53.76
|
| Rate for Payer: United Healthcare All Payer |
$49.28
|
|
|
OMM 9-10 BODY REGIONS
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 98929
|
| Hospital Charge Code |
76102510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$19.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Humana KY Medicaid |
$19.95
|
| Rate for Payer: Humana Medicare Advantage |
$23.38
|
| Rate for Payer: Kentucky WC Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
OMM 9-10 BODY REGIONS
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 98929
|
| Hospital Charge Code |
76102510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.24
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
OMM 9-10 BODY REGIONS
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 98929
|
| Hospital Charge Code |
45000318
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$20.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$20.63
|
| Rate for Payer: Humana Medicare Advantage |
$23.38
|
| Rate for Payer: Kentucky WC Medicaid |
$20.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
OMM 9-10 BODY REGIONS
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 98929
|
| Hospital Charge Code |
45000318
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
OMNI CATH 120CM
|
Facility
|
OP
|
$23,093.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,928.12 |
| Max. Negotiated Rate |
$22,170.00 |
| Rate for Payer: Aetna Commercial |
$17,782.19
|
| Rate for Payer: Anthem Medicaid |
$7,941.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,013.12
|
| Rate for Payer: Cash Price |
$11,546.88
|
| Rate for Payer: Cigna Commercial |
$19,167.81
|
| Rate for Payer: First Health Commercial |
$21,939.06
|
| Rate for Payer: Humana Commercial |
$19,629.69
|
| Rate for Payer: Humana KY Medicaid |
$7,941.94
|
| Rate for Payer: Kentucky WC Medicaid |
$8,022.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,936.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,043.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,928.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,101.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,322.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,320.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,091.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,934.69
|
| Rate for Payer: PHCS Commercial |
$22,170.00
|
| Rate for Payer: United Healthcare All Payer |
$20,322.50
|
|
|
OMNI CATH 120CM
|
Facility
|
IP
|
$23,093.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,928.12 |
| Max. Negotiated Rate |
$22,170.00 |
| Rate for Payer: Aetna Commercial |
$17,782.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,013.12
|
| Rate for Payer: Cash Price |
$11,546.88
|
| Rate for Payer: Cigna Commercial |
$19,167.81
|
| Rate for Payer: First Health Commercial |
$21,939.06
|
| Rate for Payer: Humana Commercial |
$19,629.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,936.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,043.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,928.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,322.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,320.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,091.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,934.69
|
| Rate for Payer: PHCS Commercial |
$22,170.00
|
| Rate for Payer: United Healthcare All Payer |
$20,322.50
|
|
|
OMNICEF 250MG 5ML SUSP 60ML
|
Facility
|
IP
|
$9.67
|
|
|
Service Code
|
NDC 68180072304
|
| Hospital Charge Code |
25001125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.54
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna Commercial |
$8.03
|
| Rate for Payer: First Health Commercial |
$9.19
|
| Rate for Payer: Humana Commercial |
$8.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.51
|
| Rate for Payer: Ohio Health Group HMO |
$7.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.67
|
| Rate for Payer: PHCS Commercial |
$9.28
|
| Rate for Payer: United Healthcare All Payer |
$8.51
|
|
|
OMNICEF 250MG 5ML SUSP 60ML
|
Facility
|
OP
|
$9.67
|
|
|
Service Code
|
NDC 68180072304
|
| Hospital Charge Code |
25001125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Anthem Medicaid |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.54
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna Commercial |
$8.03
|
| Rate for Payer: First Health Commercial |
$9.19
|
| Rate for Payer: Humana Commercial |
$8.22
|
| Rate for Payer: Humana KY Medicaid |
$3.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.51
|
| Rate for Payer: Ohio Health Group HMO |
$7.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.67
|
| Rate for Payer: PHCS Commercial |
$9.28
|
| Rate for Payer: United Healthcare All Payer |
$8.51
|
|
|
OMNICEFCEFDINIR125MG/5ML60MLSU
|
Facility
|
IP
|
$9.25
|
|
|
Service Code
|
NDC 68180072205
|
| Hospital Charge Code |
25001126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Aetna Commercial |
$7.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.21
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cigna Commercial |
$7.68
|
| Rate for Payer: First Health Commercial |
$8.79
|
| Rate for Payer: Humana Commercial |
$7.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.14
|
| Rate for Payer: Ohio Health Group HMO |
$6.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.38
|
| Rate for Payer: PHCS Commercial |
$8.88
|
| Rate for Payer: United Healthcare All Payer |
$8.14
|
|
|
OMNICEFCEFDINIR125MG/5ML60MLSU
|
Facility
|
OP
|
$9.25
|
|
|
Service Code
|
NDC 68180072205
|
| Hospital Charge Code |
25001126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Aetna Commercial |
$7.12
|
| Rate for Payer: Anthem Medicaid |
$3.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.21
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cigna Commercial |
$7.68
|
| Rate for Payer: First Health Commercial |
$8.79
|
| Rate for Payer: Humana Commercial |
$7.86
|
| Rate for Payer: Humana KY Medicaid |
$3.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.14
|
| Rate for Payer: Ohio Health Group HMO |
$6.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.38
|
| Rate for Payer: PHCS Commercial |
$8.88
|
| Rate for Payer: United Healthcare All Payer |
$8.14
|
|
|
OMNICEF (CEFDINIR) 300MG CAP
|
Facility
|
IP
|
$9.21
|
|
|
Service Code
|
NDC 68001036206
|
| Hospital Charge Code |
25003312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: Aetna Commercial |
$7.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.18
|
| Rate for Payer: Cash Price |
$4.61
|
| Rate for Payer: Cigna Commercial |
$7.64
|
| Rate for Payer: First Health Commercial |
$8.75
|
| Rate for Payer: Humana Commercial |
$7.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.10
|
| Rate for Payer: Ohio Health Group HMO |
$6.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.35
|
| Rate for Payer: PHCS Commercial |
$8.84
|
| Rate for Payer: United Healthcare All Payer |
$8.10
|
|
