|
ONYX FRONTIER 5.0*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 5.0*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
|
|
|
OPANA 10MG TABLET
|
Facility
|
OP
|
$64.13
|
|
|
Service Code
|
NDC 10702007106
|
| Hospital Charge Code |
25001131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$61.56 |
| Rate for Payer: Aetna Commercial |
$49.38
|
| Rate for Payer: Anthem Medicaid |
$22.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.02
|
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Cigna Commercial |
$53.23
|
| Rate for Payer: First Health Commercial |
$60.92
|
| Rate for Payer: Humana Commercial |
$54.51
|
| Rate for Payer: Humana KY Medicaid |
$22.05
|
| Rate for Payer: Kentucky WC Medicaid |
$22.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.43
|
| Rate for Payer: Ohio Health Group HMO |
$48.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.25
|
| Rate for Payer: PHCS Commercial |
$61.56
|
| Rate for Payer: United Healthcare All Payer |
$56.43
|
|
|
OPANA 10MG TABLET
|
Facility
|
IP
|
$64.13
|
|
|
Service Code
|
NDC 10702007106
|
| Hospital Charge Code |
25001131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$61.56 |
| Rate for Payer: Aetna Commercial |
$49.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.02
|
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Cigna Commercial |
$53.23
|
| Rate for Payer: First Health Commercial |
$60.92
|
| Rate for Payer: Humana Commercial |
$54.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.43
|
| Rate for Payer: Ohio Health Group HMO |
$48.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.25
|
| Rate for Payer: PHCS Commercial |
$61.56
|
| Rate for Payer: United Healthcare All Payer |
$56.43
|
|
|
OPANA ER 10MG TABLET
|
Facility
|
OP
|
$70.13
|
|
|
Service Code
|
NDC 64896069701
|
| Hospital Charge Code |
25003315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.04 |
| Max. Negotiated Rate |
$67.32 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Anthem Medicaid |
$24.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.70
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Cigna Commercial |
$58.21
|
| Rate for Payer: First Health Commercial |
$66.62
|
| Rate for Payer: Humana Commercial |
$59.61
|
| Rate for Payer: Humana KY Medicaid |
$24.12
|
| Rate for Payer: Kentucky WC Medicaid |
$24.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.71
|
| Rate for Payer: Ohio Health Group HMO |
$52.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.39
|
| Rate for Payer: PHCS Commercial |
$67.32
|
| Rate for Payer: United Healthcare All Payer |
$61.71
|
|
|
OPANA ER 10MG TABLET
|
Facility
|
IP
|
$70.13
|
|
|
Service Code
|
NDC 64896069701
|
| Hospital Charge Code |
25003315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.04 |
| Max. Negotiated Rate |
$67.32 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.70
|
| Rate for Payer: Cash Price |
$35.06
|
| Rate for Payer: Cigna Commercial |
$58.21
|
| Rate for Payer: First Health Commercial |
$66.62
|
| Rate for Payer: Humana Commercial |
$59.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.71
|
| Rate for Payer: Ohio Health Group HMO |
$52.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.39
|
| Rate for Payer: PHCS Commercial |
$67.32
|
| Rate for Payer: United Healthcare All Payer |
$61.71
|
|
|
OP CARD REHAB W/O ECG MONITOR
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$232.44
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.62
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
OP CARD REHAB W/O ECG MONITOR
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem Medicaid |
$102.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$116.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$232.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$162.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$157.06
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Humana KY Medicaid |
$102.48
|
| Rate for Payer: Humana Medicare Advantage |
$116.34
|
| Rate for Payer: Kentucky WC Medicaid |
$103.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$104.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.62
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
OPDIVO 240MG/24ML VIAL
|
Facility
|
IP
|
$42,440.95
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
25002665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,732.28 |
| Max. Negotiated Rate |
$40,743.31 |
| Rate for Payer: Aetna Commercial |
$32,679.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,103.94
|
| Rate for Payer: Cash Price |
$21,220.47
|
| Rate for Payer: Cigna Commercial |
$35,225.99
|
| Rate for Payer: First Health Commercial |
$40,318.90
|
| Rate for Payer: Humana Commercial |
$36,074.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,801.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,321.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,732.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,348.04
|
| Rate for Payer: Ohio Health Group HMO |
$31,830.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,952.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,923.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,284.26
|
| Rate for Payer: PHCS Commercial |
$40,743.31
|
| Rate for Payer: United Healthcare All Payer |
$37,348.04
|
|
|
OPDIVO 240MG/24ML VIAL
|
Facility
|
OP
|
$42,440.95
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
25002665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$40,743.31 |
| Rate for Payer: Aetna Commercial |
$32,679.53
|
| Rate for Payer: Anthem Medicaid |
$14,595.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$33.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,103.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$46.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.55
|
| Rate for Payer: Cash Price |
$21,220.47
|
| Rate for Payer: Cash Price |
$21,220.47
|
| Rate for Payer: Cigna Commercial |
$35,225.99
|
| Rate for Payer: First Health Commercial |
$40,318.90
|
| Rate for Payer: Humana Commercial |
$36,074.81
|
| Rate for Payer: Humana KY Medicaid |
$14,595.44
|
| Rate for Payer: Humana Medicare Advantage |
$33.00
|
| Rate for Payer: Kentucky WC Medicaid |
$14,743.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,801.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,321.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,888.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,348.04
|
| Rate for Payer: Ohio Health Group HMO |
$31,830.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,952.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,923.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,284.26
|
| Rate for Payer: PHCS Commercial |
$40,743.31
|
| Rate for Payer: United Healthcare All Payer |
$37,348.04
|
|
|
OPDIVO 40MG/4ML VIAL
|
Facility
|
OP
|
$7,073.50
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
25002666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$6,790.56 |
| Rate for Payer: Aetna Commercial |
$5,446.60
|
| Rate for Payer: Anthem Medicaid |
$2,432.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$33.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,517.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$46.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.55
|
| Rate for Payer: Cash Price |
$3,536.75
|
| Rate for Payer: Cash Price |
$3,536.75
|
| Rate for Payer: Cigna Commercial |
$5,871.01
|
| Rate for Payer: First Health Commercial |
$6,719.82
|
| Rate for Payer: Humana Commercial |
$6,012.48
|
| Rate for Payer: Humana KY Medicaid |
$2,432.58
|
| Rate for Payer: Humana Medicare Advantage |
$33.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,457.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,800.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,220.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,481.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,224.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,305.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,658.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,153.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,880.72
|
| Rate for Payer: PHCS Commercial |
$6,790.56
|
| Rate for Payer: United Healthcare All Payer |
$6,224.68
|
|
|
OPDIVO 40MG/4ML VIAL
|
Facility
|
IP
|
$7,073.50
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
25002666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,122.05 |
| Max. Negotiated Rate |
$6,790.56 |
| Rate for Payer: Aetna Commercial |
$5,446.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,517.33
|
| Rate for Payer: Cash Price |
$3,536.75
|
| Rate for Payer: Cigna Commercial |
$5,871.01
|
| Rate for Payer: First Health Commercial |
$6,719.82
|
| Rate for Payer: Humana Commercial |
$6,012.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,800.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,220.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,122.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,224.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,305.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,658.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,153.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,880.72
|
| Rate for Payer: PHCS Commercial |
$6,790.56
|
| Rate for Payer: United Healthcare All Payer |
$6,224.68
|
|
|
OPDUALAG 3/1mg(480/160mg/2SDV)
|
Facility
|
OP
|
$164,803.42
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
25004261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$197.65 |
| Max. Negotiated Rate |
$158,211.28 |
| Rate for Payer: Aetna Commercial |
$126,898.63
|
| Rate for Payer: Anthem Medicaid |
$56,675.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$197.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128,546.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$276.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$266.83
|
| Rate for Payer: Cash Price |
$82,401.71
|
| Rate for Payer: Cash Price |
$82,401.71
|
| Rate for Payer: Cigna Commercial |
$136,786.84
|
| Rate for Payer: First Health Commercial |
$156,563.25
|
| Rate for Payer: Humana Commercial |
$140,082.91
|
| Rate for Payer: Humana KY Medicaid |
$56,675.90
|
| Rate for Payer: Humana Medicare Advantage |
$197.65
|
| Rate for Payer: Kentucky WC Medicaid |
$57,252.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135,138.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121,624.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$57,813.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$145,027.01
|
| Rate for Payer: Ohio Health Group HMO |
$123,602.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131,842.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143,378.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113,714.36
|
| Rate for Payer: PHCS Commercial |
$158,211.28
|
| Rate for Payer: United Healthcare All Payer |
$145,027.01
|
|
|
OPDUALAG 3/1mg(480/160mg/2SDV)
|
Facility
|
IP
|
$164,803.42
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
25004261
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49,441.03 |
| Max. Negotiated Rate |
$158,211.28 |
| Rate for Payer: Aetna Commercial |
$126,898.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128,546.67
|
| Rate for Payer: Cash Price |
$82,401.71
|
| Rate for Payer: Cigna Commercial |
$136,786.84
|
| Rate for Payer: First Health Commercial |
$156,563.25
|
| Rate for Payer: Humana Commercial |
$140,082.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135,138.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121,624.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49,441.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$145,027.01
|
| Rate for Payer: Ohio Health Group HMO |
$123,602.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131,842.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143,378.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113,714.36
|
| Rate for Payer: PHCS Commercial |
$158,211.28
|
| Rate for Payer: United Healthcare All Payer |
$145,027.01
|
|
|
OPEN AORTIC TUBE PROSTH REPR
|
Facility
|
IP
|
$2,040.00
|
|
|
Service Code
|
HCPCS 34830
|
| Hospital Charge Code |
36001271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$1,958.40 |
| Rate for Payer: Aetna Commercial |
$1,570.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$1,693.20
|
| Rate for Payer: First Health Commercial |
$1,938.00
|
| Rate for Payer: Humana Commercial |
$1,734.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,672.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,505.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,795.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,774.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,407.60
|
| Rate for Payer: PHCS Commercial |
$1,958.40
|
| Rate for Payer: United Healthcare All Payer |
$1,795.20
|
|
|
OPEN AORTIC TUBE PROSTH REPR
|
Facility
|
OP
|
$2,040.00
|
|
|
Service Code
|
HCPCS 34830
|
| Hospital Charge Code |
36001271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$1,958.40 |
| Rate for Payer: Aetna Commercial |
$1,570.80
|
| Rate for Payer: Anthem Medicaid |
$701.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$1,693.20
|
| Rate for Payer: First Health Commercial |
$1,938.00
|
| Rate for Payer: Humana Commercial |
$1,734.00
|
| Rate for Payer: Humana KY Medicaid |
$701.56
|
| Rate for Payer: Kentucky WC Medicaid |
$708.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,672.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,505.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,795.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,774.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,407.60
|
| Rate for Payer: PHCS Commercial |
$1,958.40
|
| Rate for Payer: United Healthcare All Payer |
$1,795.20
|
|
|
OPEN AORTIC TUBE PROSTH REPR
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 34830
|
| Hospital Charge Code |
36001271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$714.00 |
| Max. Negotiated Rate |
$3,224.64 |
| Rate for Payer: Aetna Commercial |
$3,224.64
|
| Rate for Payer: Ambetter Exchange |
$1,659.11
|
| Rate for Payer: Anthem Medicaid |
$1,378.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,659.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,659.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,990.93
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$3,083.04
|
| Rate for Payer: Healthspan PPO |
$3,170.45
|
| Rate for Payer: Humana Medicaid |
$1,378.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,477.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,659.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,406.25
|
| Rate for Payer: Molina Healthcare Passport |
$1,378.68
|
| Rate for Payer: Multiplan PHCS |
$1,224.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,156.84
|
| Rate for Payer: UHCCP Medicaid |
$714.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,392.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,659.11
|
|
|
OPEN AORTIC TUBE PROSTH REPR
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 34830
|
| Hospital Charge Code |
360P1271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$714.00 |
| Max. Negotiated Rate |
$3,224.64 |
| Rate for Payer: Aetna Commercial |
$3,224.64
|
| Rate for Payer: Ambetter Exchange |
$1,659.11
|
| Rate for Payer: Anthem Medicaid |
$1,378.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,659.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,659.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,990.93
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$3,083.04
|
| Rate for Payer: Healthspan PPO |
$3,170.45
|
| Rate for Payer: Humana Medicaid |
$1,378.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,477.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,659.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,406.25
|
| Rate for Payer: Molina Healthcare Passport |
$1,378.68
|
| Rate for Payer: Multiplan PHCS |
$1,224.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,156.84
|
| Rate for Payer: UHCCP Medicaid |
$714.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,392.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,659.11
|
|
|
OPEN AORTOILIAC PROSTH REPR
|
Professional
|
Both
|
$4,550.00
|
|
|
Service Code
|
HCPCS 34831
|
| Hospital Charge Code |
76103026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,490.71 |
| Max. Negotiated Rate |
$3,421.68 |
| Rate for Payer: Aetna Commercial |
$3,421.68
|
| Rate for Payer: Ambetter Exchange |
$1,818.02
|
| Rate for Payer: Anthem Medicaid |
$1,490.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,818.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,818.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,181.62
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Cigna Commercial |
$3,194.16
|
| Rate for Payer: Healthspan PPO |
$3,364.18
|
| Rate for Payer: Humana Medicaid |
$1,490.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,645.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,818.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,818.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,520.52
|
| Rate for Payer: Molina Healthcare Passport |
$1,490.71
|
| Rate for Payer: Multiplan PHCS |
$2,730.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,363.43
|
| Rate for Payer: UHCCP Medicaid |
$1,592.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,505.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,818.02
|
|
|
OPENBIOMEFECMICROBIOME CAP(30)
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25002466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$559.50 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,622.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.85
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
OPENBIOMEFECMICROBIOME CAP(30)
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25002466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$559.50 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem Medicaid |
$641.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Humana KY Medicaid |
$641.37
|
| Rate for Payer: Kentucky WC Medicaid |
$647.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,622.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.85
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
OPENBIOME FMT 1mL (250mL)
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS J1440
|
| Hospital Charge Code |
25003316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$559.50 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,622.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.85
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
OPENBIOME FMT 1mL (250mL)
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS J1440
|
| Hospital Charge Code |
25003316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.03 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem Medicaid |
$641.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$64.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$89.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.44
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Humana KY Medicaid |
$641.37
|
| Rate for Payer: Humana Medicare Advantage |
$64.03
|
| Rate for Payer: Kentucky WC Medicaid |
$647.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,622.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.85
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
OPENBIOME FMT 1mL (30mL)
|
Facility
|
IP
|
$2,220.00
|
|
|
Service Code
|
HCPCS J1440
|
| Hospital Charge Code |
25003317
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$666.00 |
| Max. Negotiated Rate |
$2,131.20 |
| Rate for Payer: Aetna Commercial |
$1,709.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,731.60
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cigna Commercial |
$1,842.60
|
| Rate for Payer: First Health Commercial |
$2,109.00
|
| Rate for Payer: Humana Commercial |
$1,887.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,820.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,638.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$666.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,953.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,665.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,931.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.80
|
| Rate for Payer: PHCS Commercial |
$2,131.20
|
| Rate for Payer: United Healthcare All Payer |
$1,953.60
|
|
|
OPENBIOME FMT 1mL (30mL)
|
Facility
|
OP
|
$2,220.00
|
|
|
Service Code
|
HCPCS J1440
|
| Hospital Charge Code |
25003317
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.03 |
| Max. Negotiated Rate |
$2,131.20 |
| Rate for Payer: Aetna Commercial |
$1,709.40
|
| Rate for Payer: Anthem Medicaid |
$763.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$64.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,731.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$89.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.44
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cigna Commercial |
$1,842.60
|
| Rate for Payer: First Health Commercial |
$2,109.00
|
| Rate for Payer: Humana Commercial |
$1,887.00
|
| Rate for Payer: Humana KY Medicaid |
$763.46
|
| Rate for Payer: Humana Medicare Advantage |
$64.03
|
| Rate for Payer: Kentucky WC Medicaid |
$771.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,820.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,638.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$778.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,953.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,665.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,931.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,531.80
|
| Rate for Payer: PHCS Commercial |
$2,131.20
|
| Rate for Payer: United Healthcare All Payer |
$1,953.60
|
|
