|
OMNIPAQUE 240MG PERM 10X10MLVL
|
Facility
|
OP
|
$82.04
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
25003313
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$78.76 |
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Anthem Medicaid |
$28.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.99
|
| Rate for Payer: Cash Price |
$41.02
|
| Rate for Payer: Cigna Commercial |
$68.09
|
| Rate for Payer: First Health Commercial |
$77.94
|
| Rate for Payer: Humana Commercial |
$69.73
|
| Rate for Payer: Humana KY Medicaid |
$28.21
|
| Rate for Payer: Kentucky WC Medicaid |
$28.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.20
|
| Rate for Payer: Ohio Health Group HMO |
$61.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.61
|
| Rate for Payer: PHCS Commercial |
$78.76
|
| Rate for Payer: United Healthcare All Payer |
$72.20
|
|
|
OMNIPAQUE 300MG/ML (10MLVIAL)
|
Facility
|
IP
|
$78.70
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
25002749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.61 |
| Max. Negotiated Rate |
$75.55 |
| Rate for Payer: Aetna Commercial |
$60.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.39
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Cigna Commercial |
$65.32
|
| Rate for Payer: First Health Commercial |
$74.77
|
| Rate for Payer: Humana Commercial |
$66.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.26
|
| Rate for Payer: Ohio Health Group HMO |
$59.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.30
|
| Rate for Payer: PHCS Commercial |
$75.55
|
| Rate for Payer: United Healthcare All Payer |
$69.26
|
|
|
OMNIPAQUE 300MG/ML (10MLVIAL)
|
Facility
|
OP
|
$78.70
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
25002749
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.61 |
| Max. Negotiated Rate |
$75.55 |
| Rate for Payer: Aetna Commercial |
$60.60
|
| Rate for Payer: Anthem Medicaid |
$27.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.39
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Cigna Commercial |
$65.32
|
| Rate for Payer: First Health Commercial |
$74.77
|
| Rate for Payer: Humana Commercial |
$66.89
|
| Rate for Payer: Humana KY Medicaid |
$27.06
|
| Rate for Payer: Kentucky WC Medicaid |
$27.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.26
|
| Rate for Payer: Ohio Health Group HMO |
$59.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.30
|
| Rate for Payer: PHCS Commercial |
$75.55
|
| Rate for Payer: United Healthcare All Payer |
$69.26
|
|
|
OMNISPAN IMPLANT 0*
|
Facility
|
OP
|
$3,503.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.12 |
| Max. Negotiated Rate |
$3,363.60 |
| Rate for Payer: Aetna Commercial |
$2,697.89
|
| Rate for Payer: Anthem Medicaid |
$1,204.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,732.93
|
| Rate for Payer: Cash Price |
$1,751.88
|
| Rate for Payer: Cigna Commercial |
$2,908.11
|
| Rate for Payer: First Health Commercial |
$3,328.56
|
| Rate for Payer: Humana Commercial |
$2,978.19
|
| Rate for Payer: Humana KY Medicaid |
$1,204.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,585.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,627.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,803.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,048.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,417.59
|
| Rate for Payer: PHCS Commercial |
$3,363.60
|
| Rate for Payer: United Healthcare All Payer |
$3,083.30
|
|
|
OMNISPAN IMPLANT 0*
|
Facility
|
IP
|
$3,503.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.12 |
| Max. Negotiated Rate |
$3,363.60 |
| Rate for Payer: Aetna Commercial |
$2,697.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,732.93
|
| Rate for Payer: Cash Price |
$1,751.88
|
| Rate for Payer: Cigna Commercial |
$2,908.11
|
| Rate for Payer: First Health Commercial |
$3,328.56
|
| Rate for Payer: Humana Commercial |
$2,978.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,585.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,627.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,803.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,048.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,417.59
|
| Rate for Payer: PHCS Commercial |
$3,363.60
|
| Rate for Payer: United Healthcare All Payer |
$3,083.30
|
|
|
OMNISPAN IMPLANT 12
|
Facility
|
IP
|
$3,578.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.62 |
| Max. Negotiated Rate |
$3,435.60 |
| Rate for Payer: Aetna Commercial |
$2,755.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,791.43
|
| Rate for Payer: Cash Price |
$1,789.38
|
| Rate for Payer: Cigna Commercial |
$2,970.36
|
| Rate for Payer: First Health Commercial |
$3,399.81
|
| Rate for Payer: Humana Commercial |
$3,041.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,934.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,641.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,149.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,684.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,863.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,113.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,469.34
|
| Rate for Payer: PHCS Commercial |
$3,435.60
|
| Rate for Payer: United Healthcare All Payer |
$3,149.30
|
|
|
OMNISPAN IMPLANT 12
|
Facility
|
OP
|
$3,578.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.62 |
| Max. Negotiated Rate |
$3,435.60 |
| Rate for Payer: Aetna Commercial |
$2,755.64
|
| Rate for Payer: Anthem Medicaid |
$1,230.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,791.43
|
| Rate for Payer: Cash Price |
$1,789.38
|
| Rate for Payer: Cigna Commercial |
$2,970.36
|
| Rate for Payer: First Health Commercial |
$3,399.81
|
| Rate for Payer: Humana Commercial |
$3,041.94
|
| Rate for Payer: Humana KY Medicaid |
$1,230.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,243.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,934.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,641.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,255.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,149.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,684.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,863.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,113.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,469.34
|
| Rate for Payer: PHCS Commercial |
$3,435.60
|
| Rate for Payer: United Healthcare All Payer |
$3,149.30
|
|
|
OMNISPAN IMPLANT 27
|
Facility
|
OP
|
$3,578.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.62 |
| Max. Negotiated Rate |
$3,435.60 |
| Rate for Payer: Aetna Commercial |
$2,755.64
|
| Rate for Payer: Anthem Medicaid |
$1,230.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,791.43
|
| Rate for Payer: Cash Price |
$1,789.38
|
| Rate for Payer: Cigna Commercial |
$2,970.36
|
| Rate for Payer: First Health Commercial |
$3,399.81
|
| Rate for Payer: Humana Commercial |
$3,041.94
|
| Rate for Payer: Humana KY Medicaid |
$1,230.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,243.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,934.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,641.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,255.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,149.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,684.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,863.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,113.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,469.34
|
| Rate for Payer: PHCS Commercial |
$3,435.60
|
| Rate for Payer: United Healthcare All Payer |
$3,149.30
|
|
|
OMNISPAN IMPLANT 27
|
Facility
|
IP
|
$3,578.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.62 |
| Max. Negotiated Rate |
$3,435.60 |
| Rate for Payer: Aetna Commercial |
$2,755.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,791.43
|
| Rate for Payer: Cash Price |
$1,789.38
|
| Rate for Payer: Cigna Commercial |
$2,970.36
|
| Rate for Payer: First Health Commercial |
$3,399.81
|
| Rate for Payer: Humana Commercial |
$3,041.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,934.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,641.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,149.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,684.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,863.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,113.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,469.34
|
| Rate for Payer: PHCS Commercial |
$3,435.60
|
| Rate for Payer: United Healthcare All Payer |
$3,149.30
|
|
|
OMNIWIRE 185CM ST. TIP
|
Facility
|
OP
|
$4,587.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,376.25 |
| Max. Negotiated Rate |
$4,404.00 |
| Rate for Payer: Aetna Commercial |
$3,532.38
|
| Rate for Payer: Anthem Medicaid |
$1,577.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.25
|
| Rate for Payer: Cash Price |
$2,293.75
|
| Rate for Payer: Cigna Commercial |
$3,807.62
|
| Rate for Payer: First Health Commercial |
$4,358.12
|
| Rate for Payer: Humana Commercial |
$3,899.38
|
| Rate for Payer: Humana KY Medicaid |
$1,577.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.38
|
| Rate for Payer: PHCS Commercial |
$4,404.00
|
| Rate for Payer: United Healthcare All Payer |
$4,037.00
|
|
|
OMNIWIRE 185CM ST. TIP
|
Facility
|
IP
|
$4,587.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,376.25 |
| Max. Negotiated Rate |
$4,404.00 |
| Rate for Payer: Aetna Commercial |
$3,532.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.25
|
| Rate for Payer: Cash Price |
$2,293.75
|
| Rate for Payer: Cigna Commercial |
$3,807.62
|
| Rate for Payer: First Health Commercial |
$4,358.12
|
| Rate for Payer: Humana Commercial |
$3,899.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.38
|
| Rate for Payer: PHCS Commercial |
$4,404.00
|
| Rate for Payer: United Healthcare All Payer |
$4,037.00
|
|
|
ONCASPAR 750 IU / ML 5ML VIAL
|
Facility
|
OP
|
$146,142.57
|
|
|
Service Code
|
HCPCS J9266
|
| Hospital Charge Code |
25002652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28,424.06 |
| Max. Negotiated Rate |
$140,296.87 |
| Rate for Payer: Aetna Commercial |
$112,529.78
|
| Rate for Payer: Anthem Medicaid |
$50,258.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28,424.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113,991.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39,793.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$38,372.48
|
| Rate for Payer: Cash Price |
$73,071.29
|
| Rate for Payer: Cash Price |
$73,071.29
|
| Rate for Payer: Cigna Commercial |
$121,298.33
|
| Rate for Payer: First Health Commercial |
$138,835.44
|
| Rate for Payer: Humana Commercial |
$124,221.18
|
| Rate for Payer: Humana KY Medicaid |
$50,258.43
|
| Rate for Payer: Humana Medicare Advantage |
$28,424.06
|
| Rate for Payer: Kentucky WC Medicaid |
$50,769.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119,836.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107,853.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34,108.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$51,266.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$128,605.46
|
| Rate for Payer: Ohio Health Group HMO |
$109,606.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116,914.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127,144.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100,838.37
|
| Rate for Payer: PHCS Commercial |
$140,296.87
|
| Rate for Payer: United Healthcare All Payer |
$128,605.46
|
|
|
ONCASPAR 750 IU / ML 5ML VIAL
|
Facility
|
IP
|
$146,142.57
|
|
|
Service Code
|
HCPCS J9266
|
| Hospital Charge Code |
25002652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43,842.77 |
| Max. Negotiated Rate |
$140,296.87 |
| Rate for Payer: Aetna Commercial |
$112,529.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113,991.20
|
| Rate for Payer: Cash Price |
$73,071.29
|
| Rate for Payer: Cigna Commercial |
$121,298.33
|
| Rate for Payer: First Health Commercial |
$138,835.44
|
| Rate for Payer: Humana Commercial |
$124,221.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119,836.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107,853.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43,842.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$128,605.46
|
| Rate for Payer: Ohio Health Group HMO |
$109,606.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116,914.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127,144.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100,838.37
|
| Rate for Payer: PHCS Commercial |
$140,296.87
|
| Rate for Payer: United Healthcare All Payer |
$128,605.46
|
|
|
ONCOLOGY CARE MODEL SERVICE
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G9678
|
| Hospital Charge Code |
51000145
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
ONCOLOGY CARE MODEL SERVICE
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G9678
|
| Hospital Charge Code |
51000145
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
ONCOLOGY CARE MODEL SERVICE
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS G9678
|
| Hospital Charge Code |
51000145
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$214.34 |
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$214.34
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.00
|
| Rate for Payer: UHCCP Medicaid |
$56.00
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Facility
|
IP
|
$63.14
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
636T0122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$60.61 |
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Cigna Commercial |
$52.41
|
| Rate for Payer: First Health Commercial |
$59.98
|
| Rate for Payer: Humana Commercial |
$53.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.56
|
| Rate for Payer: Ohio Health Group HMO |
$47.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.57
|
| Rate for Payer: PHCS Commercial |
$60.61
|
| Rate for Payer: United Healthcare All Payer |
$55.56
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Professional
|
Both
|
$63.14
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$37.88 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Ambetter Exchange |
$0.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.11
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Healthspan PPO |
$0.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.09
|
| Rate for Payer: Multiplan PHCS |
$37.88
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.12
|
| Rate for Payer: UHCCP Medicaid |
$22.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.09
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Facility
|
IP
|
$63.14
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
25004038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$60.61 |
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Cigna Commercial |
$52.41
|
| Rate for Payer: First Health Commercial |
$59.98
|
| Rate for Payer: Humana Commercial |
$53.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.56
|
| Rate for Payer: Ohio Health Group HMO |
$47.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.57
|
| Rate for Payer: PHCS Commercial |
$60.61
|
| Rate for Payer: United Healthcare All Payer |
$55.56
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Facility
|
IP
|
$63.14
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$60.61 |
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Cigna Commercial |
$52.41
|
| Rate for Payer: First Health Commercial |
$59.98
|
| Rate for Payer: Humana Commercial |
$53.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.56
|
| Rate for Payer: Ohio Health Group HMO |
$47.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.57
|
| Rate for Payer: PHCS Commercial |
$60.61
|
| Rate for Payer: United Healthcare All Payer |
$55.56
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Facility
|
OP
|
$63.14
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
63600122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$60.61 |
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Anthem Medicaid |
$21.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Cigna Commercial |
$52.41
|
| Rate for Payer: First Health Commercial |
$59.98
|
| Rate for Payer: Humana Commercial |
$53.67
|
| Rate for Payer: Humana KY Medicaid |
$21.71
|
| Rate for Payer: Kentucky WC Medicaid |
$21.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.56
|
| Rate for Payer: Ohio Health Group HMO |
$47.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.57
|
| Rate for Payer: PHCS Commercial |
$60.61
|
| Rate for Payer: United Healthcare All Payer |
$55.56
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Facility
|
OP
|
$63.14
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
636T0122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$60.61 |
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Anthem Medicaid |
$21.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Cigna Commercial |
$52.41
|
| Rate for Payer: First Health Commercial |
$59.98
|
| Rate for Payer: Humana Commercial |
$53.67
|
| Rate for Payer: Humana KY Medicaid |
$21.71
|
| Rate for Payer: Kentucky WC Medicaid |
$21.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.56
|
| Rate for Payer: Ohio Health Group HMO |
$47.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.57
|
| Rate for Payer: PHCS Commercial |
$60.61
|
| Rate for Payer: United Healthcare All Payer |
$55.56
|
|
|
ONDANSETRON 1MG (40 MDV)
|
Facility
|
OP
|
$63.14
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
25004038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.94 |
| Max. Negotiated Rate |
$60.61 |
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Anthem Medicaid |
$21.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Cash Price |
$31.57
|
| Rate for Payer: Cigna Commercial |
$52.41
|
| Rate for Payer: First Health Commercial |
$59.98
|
| Rate for Payer: Humana Commercial |
$53.67
|
| Rate for Payer: Humana KY Medicaid |
$21.71
|
| Rate for Payer: Kentucky WC Medicaid |
$21.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.56
|
| Rate for Payer: Ohio Health Group HMO |
$47.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.57
|
| Rate for Payer: PHCS Commercial |
$60.61
|
| Rate for Payer: United Healthcare All Payer |
$55.56
|
|
|
ONE-WAY ALLOW PRORATED MILES
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS P9603
|
| Hospital Charge Code |
30001560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.77
|
| Rate for Payer: Anthem Medicaid |
$0.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.83
|
| Rate for Payer: First Health Commercial |
$0.95
|
| Rate for Payer: Humana Commercial |
$0.85
|
| Rate for Payer: Humana KY Medicaid |
$0.34
|
| Rate for Payer: Kentucky WC Medicaid |
$0.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.88
|
| Rate for Payer: Ohio Health Group HMO |
$0.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.69
|
| Rate for Payer: PHCS Commercial |
$0.96
|
| Rate for Payer: United Healthcare All Payer |
$0.88
|
|
|
ONE-WAY ALLOW PRORATED MILES
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS P9603
|
| Hospital Charge Code |
30001560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.80
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna Commercial |
$0.83
|
| Rate for Payer: First Health Commercial |
$0.95
|
| Rate for Payer: Humana Commercial |
$0.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.88
|
| Rate for Payer: Ohio Health Group HMO |
$0.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.69
|
| Rate for Payer: PHCS Commercial |
$0.96
|
| Rate for Payer: United Healthcare All Payer |
$0.88
|
|
