|
OS AMCA AB
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.68 |
| Max. Negotiated Rate |
$226.56 |
| Rate for Payer: Aetna Commercial |
$181.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.51
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$195.88
|
| Rate for Payer: First Health Commercial |
$224.20
|
| Rate for Payer: Humana Commercial |
$200.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$193.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$207.68
|
| Rate for Payer: Ohio Health Group HMO |
$177.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.16
|
| Rate for Payer: PHCS Commercial |
$226.56
|
| Rate for Payer: United Healthcare All Payer |
$207.68
|
|
|
OS AMCA AB
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$226.56 |
| Rate for Payer: Aetna Commercial |
$181.72
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$189.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Cigna Commercial |
$195.88
|
| Rate for Payer: First Health Commercial |
$224.20
|
| Rate for Payer: Humana Commercial |
$200.60
|
| Rate for Payer: Humana KY Medicaid |
$11.53
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Kentucky WC Medicaid |
$11.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$193.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$207.68
|
| Rate for Payer: Ohio Health Group HMO |
$177.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.16
|
| Rate for Payer: PHCS Commercial |
$226.56
|
| Rate for Payer: United Healthcare All Payer |
$207.68
|
|
|
OS AMIKACIN PEAK
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
30000017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS AMIKACIN PEAK
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
30000017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem Medicaid |
$15.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.08
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Humana KY Medicaid |
$15.08
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$15.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS AMIKACIN RANDOM
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
30000016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS AMIKACIN RANDOM
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
30000016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem Medicaid |
$15.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.08
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Humana KY Medicaid |
$15.08
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$15.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS AMIKACIN TROUGH
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
30000018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem Medicaid |
$15.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.08
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Humana KY Medicaid |
$15.08
|
| Rate for Payer: Humana Medicare Advantage |
$15.08
|
| Rate for Payer: Kentucky WC Medicaid |
$15.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS AMIKACIN TROUGH
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
30000018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.65
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
OS AMINO ACID QN ION EXCH U
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 82139
|
| Hospital Charge Code |
30000236
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$16.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.87
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$16.87
|
| Rate for Payer: Humana Medicare Advantage |
$16.87
|
| Rate for Payer: Kentucky WC Medicaid |
$17.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
OS AMINO ACID QN ION EXCH U
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 82139
|
| Hospital Charge Code |
30000236
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.05
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
OS AMINO ACIDS QUANT 2-5
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 82136
|
| Hospital Charge Code |
30002020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem Medicaid |
$19.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.61
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Humana KY Medicaid |
$19.61
|
| Rate for Payer: Humana Medicare Advantage |
$19.61
|
| Rate for Payer: Kentucky WC Medicaid |
$19.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.78
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
OS AMINO ACIDS QUANT 2-5
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 82136
|
| Hospital Charge Code |
30002020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$110.81
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.78
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
OS AMINOLEVULIC ACID URINE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 82135
|
| Hospital Charge Code |
30000235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.05
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
OS AMINOLEVULIC ACID URINE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 82135
|
| Hospital Charge Code |
30000235
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$16.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.45
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$16.45
|
| Rate for Payer: Humana Medicare Advantage |
$16.45
|
| Rate for Payer: Kentucky WC Medicaid |
$16.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
OS AMIODARONE S
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 80151
|
| Hospital Charge Code |
30000054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem Medicaid |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Humana KY Medicaid |
$18.64
|
| Rate for Payer: Humana Medicare Advantage |
$18.64
|
| Rate for Payer: Kentucky WC Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.21
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS AMIODARONE S
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 80151
|
| Hospital Charge Code |
30000054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$153.37
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.21
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
OS AMITRIPTYLINE
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.09
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.76
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
OS AMITRIPTYLINE
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| 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 |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.76
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
OS AMOXICILLIN IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000823
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS AMOXICILLIN IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000823
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS AMPHETAINES URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| 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 |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS AMPHETAINES URINE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80326
|
| Hospital Charge Code |
30000085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$26.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Multiplan PHCS |
$15.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.20
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
|
|
OS AMPHETAINES URINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS AMPHETAMINES
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.45
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
OS AMPHETAMINES
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| 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 |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.45
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
