|
ORTHOVISC 30MG/2ML SYRINGE
|
Facility
|
OP
|
$2,605.10
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
636T0169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.70 |
| Max. Negotiated Rate |
$2,500.90 |
| Rate for Payer: Aetna Commercial |
$2,005.93
|
| Rate for Payer: Anthem Medicaid |
$895.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$97.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,031.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$136.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.90
|
| Rate for Payer: Cash Price |
$1,302.55
|
| Rate for Payer: Cash Price |
$1,302.55
|
| Rate for Payer: Cigna Commercial |
$2,162.23
|
| Rate for Payer: First Health Commercial |
$2,474.84
|
| Rate for Payer: Humana Commercial |
$2,214.34
|
| Rate for Payer: Humana KY Medicaid |
$895.89
|
| Rate for Payer: Humana Medicare Advantage |
$97.70
|
| Rate for Payer: Kentucky WC Medicaid |
$905.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,136.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,922.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$913.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,292.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,953.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,084.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,266.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,797.52
|
| Rate for Payer: PHCS Commercial |
$2,500.90
|
| Rate for Payer: United Healthcare All Payer |
$2,292.49
|
|
|
ORTHOVISC 30MG/2ML SYRINGE
|
Facility
|
OP
|
$2,605.10
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.70 |
| Max. Negotiated Rate |
$2,500.90 |
| Rate for Payer: Aetna Commercial |
$2,005.93
|
| Rate for Payer: Anthem Medicaid |
$895.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$97.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,031.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$136.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$131.90
|
| Rate for Payer: Cash Price |
$1,302.55
|
| Rate for Payer: Cash Price |
$1,302.55
|
| Rate for Payer: Cigna Commercial |
$2,162.23
|
| Rate for Payer: First Health Commercial |
$2,474.84
|
| Rate for Payer: Humana Commercial |
$2,214.34
|
| Rate for Payer: Humana KY Medicaid |
$895.89
|
| Rate for Payer: Humana Medicare Advantage |
$97.70
|
| Rate for Payer: Kentucky WC Medicaid |
$905.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,136.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,922.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$913.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,292.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,953.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,084.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,266.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,797.52
|
| Rate for Payer: PHCS Commercial |
$2,500.90
|
| Rate for Payer: United Healthcare All Payer |
$2,292.49
|
|
|
ORTHOVISC 30MG/2ML SYRINGE
|
Facility
|
IP
|
$2,605.10
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
25004255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$781.53 |
| Max. Negotiated Rate |
$2,500.90 |
| Rate for Payer: Aetna Commercial |
$2,005.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,031.98
|
| Rate for Payer: Cash Price |
$1,302.55
|
| Rate for Payer: Cigna Commercial |
$2,162.23
|
| Rate for Payer: First Health Commercial |
$2,474.84
|
| Rate for Payer: Humana Commercial |
$2,214.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,136.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,922.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$781.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,292.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,953.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,084.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,266.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,797.52
|
| Rate for Payer: PHCS Commercial |
$2,500.90
|
| Rate for Payer: United Healthcare All Payer |
$2,292.49
|
|
|
ORTHOVISC 30MG/2ML SYRINGE
|
Facility
|
IP
|
$2,605.10
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
636T0169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$781.53 |
| Max. Negotiated Rate |
$2,500.90 |
| Rate for Payer: Aetna Commercial |
$2,005.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,031.98
|
| Rate for Payer: Cash Price |
$1,302.55
|
| Rate for Payer: Cigna Commercial |
$2,162.23
|
| Rate for Payer: First Health Commercial |
$2,474.84
|
| Rate for Payer: Humana Commercial |
$2,214.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,136.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,922.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$781.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,292.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,953.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,084.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,266.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,797.52
|
| Rate for Payer: PHCS Commercial |
$2,500.90
|
| Rate for Payer: United Healthcare All Payer |
$2,292.49
|
|
|
ORUDIS 50MG CAPSULE
|
Facility
|
IP
|
$4.42
|
|
|
Service Code
|
NDC 378407001
|
| Hospital Charge Code |
25001142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.67
|
| Rate for Payer: First Health Commercial |
$4.20
|
| Rate for Payer: Humana Commercial |
$3.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.89
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
ORUDIS 50MG CAPSULE
|
Facility
|
OP
|
$4.42
|
|
|
Service Code
|
NDC 378407001
|
| Hospital Charge Code |
25001142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.45
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.67
|
| Rate for Payer: First Health Commercial |
$4.20
|
| Rate for Payer: Humana Commercial |
$3.76
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.89
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.05
|
| Rate for Payer: PHCS Commercial |
$4.24
|
| Rate for Payer: United Healthcare All Payer |
$3.89
|
|
|
OS 11-DEOXYCORTISOL
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 82634
|
| Hospital Charge Code |
30001947
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$29.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$40.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.28
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Humana KY Medicaid |
$29.28
|
| Rate for Payer: Humana Medicare Advantage |
$29.28
|
| Rate for Payer: Kentucky WC Medicaid |
$29.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
OS 11-DEOXYCORTISOL
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 82634
|
| Hospital Charge Code |
30001947
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
OS 17 HYDROXYPREGNENOLONE S
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
HCPCS 84143
|
| Hospital Charge Code |
30000483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$237.12 |
| Rate for Payer: Aetna Commercial |
$190.19
|
| Rate for Payer: Anthem Medicaid |
$22.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$198.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.81
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cigna Commercial |
$205.01
|
| Rate for Payer: First Health Commercial |
$234.65
|
| Rate for Payer: Humana Commercial |
$209.95
|
| Rate for Payer: Humana KY Medicaid |
$22.81
|
| Rate for Payer: Humana Medicare Advantage |
$22.81
|
| Rate for Payer: Kentucky WC Medicaid |
$23.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$202.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$182.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$217.36
|
| Rate for Payer: Ohio Health Group HMO |
$185.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.43
|
| Rate for Payer: PHCS Commercial |
$237.12
|
| Rate for Payer: United Healthcare All Payer |
$217.36
|
|
|
OS 17 HYDROXYPREGNENOLONE S
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
HCPCS 84143
|
| Hospital Charge Code |
30000483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$237.12 |
| Rate for Payer: Aetna Commercial |
$190.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$198.34
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cigna Commercial |
$205.01
|
| Rate for Payer: First Health Commercial |
$234.65
|
| Rate for Payer: Humana Commercial |
$209.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$202.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$182.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$217.36
|
| Rate for Payer: Ohio Health Group HMO |
$185.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.43
|
| Rate for Payer: PHCS Commercial |
$237.12
|
| Rate for Payer: United Healthcare All Payer |
$217.36
|
|
|
OS 17 HYDROXYPROGESTERONE S
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 83498
|
| Hospital Charge Code |
30000372
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Aetna Commercial |
$37.86
|
| Rate for Payer: Ambetter Exchange |
$27.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$27.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$27.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.60
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$23.99
|
| Rate for Payer: Healthspan PPO |
$28.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$27.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.17
|
| Rate for Payer: Multiplan PHCS |
$167.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.32
|
| Rate for Payer: UHCCP Medicaid |
$97.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.17
|
|
|
OS 17 HYDROXYPROGESTERONE S
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
HCPCS 83498
|
| Hospital Charge Code |
30000372
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$214.83
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.17
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$231.57
|
| Rate for Payer: First Health Commercial |
$265.05
|
| Rate for Payer: Humana Commercial |
$237.15
|
| Rate for Payer: Humana KY Medicaid |
$27.17
|
| Rate for Payer: Humana Medicare Advantage |
$27.17
|
| Rate for Payer: Kentucky WC Medicaid |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$228.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$245.52
|
| Rate for Payer: Ohio Health Group HMO |
$209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.51
|
| Rate for Payer: PHCS Commercial |
$267.84
|
| Rate for Payer: United Healthcare All Payer |
$245.52
|
|
|
OS 17 HYDROXYPROGESTERONE S
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
HCPCS 83498
|
| Hospital Charge Code |
30000372
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$214.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.04
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$231.57
|
| Rate for Payer: First Health Commercial |
$265.05
|
| Rate for Payer: Humana Commercial |
$237.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$228.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$245.52
|
| Rate for Payer: Ohio Health Group HMO |
$209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.51
|
| Rate for Payer: PHCS Commercial |
$267.84
|
| Rate for Payer: United Healthcare All Payer |
$245.52
|
|
|
OS 2,3-DINOR 11B-PROSTA F2A, U
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 84150
|
| Hospital Charge Code |
30001868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
OS 2,3-DINOR 11B-PROSTA F2A, U
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 84150
|
| Hospital Charge Code |
30001868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$41.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$58.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.77
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$41.77
|
| Rate for Payer: Humana Medicare Advantage |
$41.77
|
| Rate for Payer: Kentucky WC Medicaid |
$42.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
OS 6 ACETYLMORPHINE CONFIRM UR
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS 80356
|
| Hospital Charge Code |
30000135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem Medicaid |
$118.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$277.04
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Humana KY Medicaid |
$118.65
|
| Rate for Payer: Kentucky WC Medicaid |
$119.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.05
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
|
OS 6 ACETYLMORPHINE CONFIRM UR
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$277.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.05
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
|
OS 6 ACETYLMORPHINE CONFIRM UR
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS 80356
|
| Hospital Charge Code |
30000135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$277.04
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.05
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
|
OS 6 ACETYLMORPHINE CONFIRM UR
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$277.04
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.05
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
|
OS A1AT/Fatty Acid Profile
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
30000290
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$185.28 |
| Rate for Payer: Aetna Commercial |
$148.61
|
| Rate for Payer: Anthem Medicaid |
$24.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.09
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$160.19
|
| Rate for Payer: First Health Commercial |
$183.35
|
| Rate for Payer: Humana Commercial |
$164.05
|
| Rate for Payer: Humana KY Medicaid |
$24.09
|
| Rate for Payer: Humana Medicare Advantage |
$24.09
|
| Rate for Payer: Kentucky WC Medicaid |
$24.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$158.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$142.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$169.84
|
| Rate for Payer: Ohio Health Group HMO |
$144.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.17
|
| Rate for Payer: PHCS Commercial |
$185.28
|
| Rate for Payer: United Healthcare All Payer |
$169.84
|
|
|
OS A1AT/Fatty Acid Profile
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
30000290
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$185.28 |
| Rate for Payer: Aetna Commercial |
$148.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Cash Price |
$96.50
|
| Rate for Payer: Cigna Commercial |
$160.19
|
| Rate for Payer: First Health Commercial |
$183.35
|
| Rate for Payer: Humana Commercial |
$164.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$158.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$142.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$169.84
|
| Rate for Payer: Ohio Health Group HMO |
$144.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.17
|
| Rate for Payer: PHCS Commercial |
$185.28
|
| Rate for Payer: United Healthcare All Payer |
$169.84
|
|
|
OS ABSOLUT CD4CD8 CNT W RATIO
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
30001087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$46.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.98
|
| Rate for Payer: Cash Price |
$80.00
|
| 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 |
$46.98
|
| Rate for Payer: Humana Medicare Advantage |
$46.98
|
| Rate for Payer: Kentucky WC Medicaid |
$47.45
|
| 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 |
$56.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.92
|
| 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
|
|
|
OS ABSOLUT CD4CD8 CNT W RATIO
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
30001087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| 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
|
|
|
OS AB TO ADALIMUMAB
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
30001955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$722.70
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
OS AB TO ADALIMUMAB
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
30001955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$24.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$722.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.09
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$24.09
|
| Rate for Payer: Humana Medicare Advantage |
$24.09
|
| Rate for Payer: Kentucky WC Medicaid |
$24.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
