|
ONE-WAY ALLOW PRORATED TRIP
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS P9604
|
| Hospital Charge Code |
30001561
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.03
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.30
|
| Rate for Payer: First Health Commercial |
$9.50
|
| Rate for Payer: Humana Commercial |
$8.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.80
|
| Rate for Payer: Ohio Health Group HMO |
$7.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Payer |
$8.80
|
|
|
ONE-WAY ALLOW PRORATED TRIP
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS P9604
|
| Hospital Charge Code |
30001561
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Anthem Medicaid |
$3.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.03
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.30
|
| Rate for Payer: First Health Commercial |
$9.50
|
| Rate for Payer: Humana Commercial |
$8.50
|
| Rate for Payer: Humana KY Medicaid |
$3.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.80
|
| Rate for Payer: Ohio Health Group HMO |
$7.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Payer |
$8.80
|
|
|
ONIVYDE 1MG(43MG/10ML SDV)
|
Facility
|
IP
|
$16,235.55
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
25004487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,870.66 |
| Max. Negotiated Rate |
$15,586.13 |
| Rate for Payer: Aetna Commercial |
$12,501.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,663.73
|
| Rate for Payer: Cash Price |
$8,117.77
|
| Rate for Payer: Cigna Commercial |
$13,475.51
|
| Rate for Payer: First Health Commercial |
$15,423.77
|
| Rate for Payer: Humana Commercial |
$13,800.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,313.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,981.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,870.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,287.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,176.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,988.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,124.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,202.53
|
| Rate for Payer: PHCS Commercial |
$15,586.13
|
| Rate for Payer: United Healthcare All Payer |
$14,287.28
|
|
|
ONIVYDE 1MG(43MG/10ML SDV)
|
Facility
|
OP
|
$16,235.55
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
25004487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.26 |
| Max. Negotiated Rate |
$15,586.13 |
| Rate for Payer: Aetna Commercial |
$12,501.37
|
| Rate for Payer: Anthem Medicaid |
$5,583.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$65.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,663.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$91.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$88.10
|
| Rate for Payer: Cash Price |
$8,117.77
|
| Rate for Payer: Cash Price |
$8,117.77
|
| Rate for Payer: Cigna Commercial |
$13,475.51
|
| Rate for Payer: First Health Commercial |
$15,423.77
|
| Rate for Payer: Humana Commercial |
$13,800.22
|
| Rate for Payer: Humana KY Medicaid |
$5,583.41
|
| Rate for Payer: Humana Medicare Advantage |
$65.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,640.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,313.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,981.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,695.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,287.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,176.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,988.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,124.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,202.53
|
| Rate for Payer: PHCS Commercial |
$15,586.13
|
| Rate for Payer: United Healthcare All Payer |
$14,287.28
|
|
|
ONTRUZANT 10MG(FROM 420MG MDV)
|
Facility
|
IP
|
$481.29
|
|
|
Service Code
|
HCPCS Q5112
|
| Hospital Charge Code |
25004022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.39 |
| Max. Negotiated Rate |
$462.04 |
| Rate for Payer: Aetna Commercial |
$370.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.41
|
| Rate for Payer: Cash Price |
$240.65
|
| Rate for Payer: Cigna Commercial |
$399.47
|
| Rate for Payer: First Health Commercial |
$457.23
|
| Rate for Payer: Humana Commercial |
$409.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.54
|
| Rate for Payer: Ohio Health Group HMO |
$360.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.09
|
| Rate for Payer: PHCS Commercial |
$462.04
|
| Rate for Payer: United Healthcare All Payer |
$423.54
|
|
|
ONTRUZANT 10MG(FROM 420MG MDV)
|
Facility
|
OP
|
$481.29
|
|
|
Service Code
|
HCPCS Q5112
|
| Hospital Charge Code |
25004022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$462.04 |
| Rate for Payer: Aetna Commercial |
$370.59
|
| Rate for Payer: Anthem Medicaid |
$165.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$375.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.69
|
| Rate for Payer: Cash Price |
$240.65
|
| Rate for Payer: Cash Price |
$240.65
|
| Rate for Payer: Cigna Commercial |
$399.47
|
| Rate for Payer: First Health Commercial |
$457.23
|
| Rate for Payer: Humana Commercial |
$409.10
|
| Rate for Payer: Humana KY Medicaid |
$165.52
|
| Rate for Payer: Humana Medicare Advantage |
$21.99
|
| Rate for Payer: Kentucky WC Medicaid |
$167.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$394.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$355.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$423.54
|
| Rate for Payer: Ohio Health Group HMO |
$360.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.09
|
| Rate for Payer: PHCS Commercial |
$462.04
|
| Rate for Payer: United Healthcare All Payer |
$423.54
|
|
|
ONTRUZANT 150 MG/7.14 ML VIAL
|
Facility
|
IP
|
$7,219.40
|
|
|
Service Code
|
HCPCS Q5112
|
| Hospital Charge Code |
25003982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,165.82 |
| Max. Negotiated Rate |
$6,930.62 |
| Rate for Payer: Aetna Commercial |
$5,558.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.13
|
| Rate for Payer: Cash Price |
$3,609.70
|
| Rate for Payer: Cigna Commercial |
$5,992.10
|
| Rate for Payer: First Health Commercial |
$6,858.43
|
| Rate for Payer: Humana Commercial |
$6,136.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,919.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,327.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,414.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,775.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,280.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,981.39
|
| Rate for Payer: PHCS Commercial |
$6,930.62
|
| Rate for Payer: United Healthcare All Payer |
$6,353.07
|
|
|
ONTRUZANT 150 MG/7.14 ML VIAL
|
Facility
|
OP
|
$7,219.40
|
|
|
Service Code
|
HCPCS Q5112
|
| Hospital Charge Code |
25003982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$6,930.62 |
| Rate for Payer: Aetna Commercial |
$5,558.94
|
| Rate for Payer: Anthem Medicaid |
$2,482.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.69
|
| Rate for Payer: Cash Price |
$3,609.70
|
| Rate for Payer: Cash Price |
$3,609.70
|
| Rate for Payer: Cigna Commercial |
$5,992.10
|
| Rate for Payer: First Health Commercial |
$6,858.43
|
| Rate for Payer: Humana Commercial |
$6,136.49
|
| Rate for Payer: Humana KY Medicaid |
$2,482.75
|
| Rate for Payer: Humana Medicare Advantage |
$21.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,508.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,919.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,327.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,414.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,775.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,280.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,981.39
|
| Rate for Payer: PHCS Commercial |
$6,930.62
|
| Rate for Payer: United Healthcare All Payer |
$6,353.07
|
|
|
ONYX FRONTIER 2.0*8
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
ONYX FRONTIER 2.0*8
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
ONYX FRONTIER 2.25*12
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*12
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*15
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*15
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*18
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*18
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*22
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*22
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*26
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*26
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*30
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*30
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*34
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*34
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
ONYX FRONTIER 2.25*38
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
