|
OS ANNA EACH TYPE
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
OS ANNA EACH TYPE
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
OS ANNA SCREEN
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS ANNA SCREEN
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$149.76 |
| Rate for Payer: Aetna Commercial |
$120.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.27
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$129.48
|
| Rate for Payer: First Health Commercial |
$148.20
|
| Rate for Payer: Humana Commercial |
$132.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.28
|
| Rate for Payer: Ohio Health Group HMO |
$117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.36
|
| Rate for Payer: PHCS Commercial |
$149.76
|
| Rate for Payer: United Healthcare All Payer |
$137.28
|
|
|
OS ANTI A4 FLA2
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$24.90
|
| Rate for Payer: First Health Commercial |
$28.50
|
| Rate for Payer: Humana Commercial |
$25.50
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.40
|
| Rate for Payer: Ohio Health Group HMO |
$22.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.30
|
| Rate for Payer: PHCS Commercial |
$28.80
|
| Rate for Payer: United Healthcare All Payer |
$26.40
|
|
|
OS ANTI A4 FLA2
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.09
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$24.90
|
| Rate for Payer: First Health Commercial |
$28.50
|
| Rate for Payer: Humana Commercial |
$25.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.40
|
| Rate for Payer: Ohio Health Group HMO |
$22.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.30
|
| Rate for Payer: PHCS Commercial |
$28.80
|
| Rate for Payer: United Healthcare All Payer |
$26.40
|
|
|
OS ANTIBODY TO DS-DNA
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
30001003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$137.28 |
| Rate for Payer: Aetna Commercial |
$110.11
|
| Rate for Payer: Anthem Medicaid |
$13.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.74
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$118.69
|
| Rate for Payer: First Health Commercial |
$135.85
|
| Rate for Payer: Humana Commercial |
$121.55
|
| Rate for Payer: Humana KY Medicaid |
$13.74
|
| Rate for Payer: Humana Medicare Advantage |
$13.74
|
| Rate for Payer: Kentucky WC Medicaid |
$13.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$117.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$105.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$125.84
|
| Rate for Payer: Ohio Health Group HMO |
$107.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.33
|
| Rate for Payer: PHCS Commercial |
$137.28
|
| Rate for Payer: United Healthcare All Payer |
$125.84
|
|
|
OS ANTIBODY TO DS-DNA
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
30001003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.59 |
| Max. Negotiated Rate |
$137.28 |
| Rate for Payer: Aetna Commercial |
$110.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.83
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$118.69
|
| Rate for Payer: First Health Commercial |
$135.85
|
| Rate for Payer: Humana Commercial |
$121.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$117.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$105.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$125.84
|
| Rate for Payer: Ohio Health Group HMO |
$107.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.33
|
| Rate for Payer: PHCS Commercial |
$137.28
|
| Rate for Payer: United Healthcare All Payer |
$125.84
|
|
|
OS ANTI CBIR1
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000398
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.09
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$24.90
|
| Rate for Payer: First Health Commercial |
$28.50
|
| Rate for Payer: Humana Commercial |
$25.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.40
|
| Rate for Payer: Ohio Health Group HMO |
$22.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.30
|
| Rate for Payer: PHCS Commercial |
$28.80
|
| Rate for Payer: United Healthcare All Payer |
$26.40
|
|
|
OS ANTI CBIR1
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000398
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$24.90
|
| Rate for Payer: First Health Commercial |
$28.50
|
| Rate for Payer: Humana Commercial |
$25.50
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.40
|
| Rate for Payer: Ohio Health Group HMO |
$22.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.30
|
| Rate for Payer: PHCS Commercial |
$28.80
|
| Rate for Payer: United Healthcare All Payer |
$26.40
|
|
|
OS ANTIDEPRESANTS
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000089
|
|
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 ANTIDEPRESANTS
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80334
|
| Hospital Charge Code |
30000089
|
|
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 ANTIDEPRESANTS
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000089
|
|
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 ANTIDEPRESANTS MH
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| 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 |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.82
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
OS ANTIDEPRESANTS MH
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.67
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cigna Commercial |
$18.26
|
| Rate for Payer: First Health Commercial |
$20.90
|
| Rate for Payer: Humana Commercial |
$18.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.36
|
| Rate for Payer: Ohio Health Group HMO |
$16.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.82
|
| Rate for Payer: PHCS Commercial |
$21.12
|
| Rate for Payer: United Healthcare All Payer |
$19.36
|
|
|
OS ANTIDEPRESSANTS 6 OR MORE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000098
|
|
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 ANTIDEPRESSANTS 6 OR MORE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80337
|
| Hospital Charge Code |
30000098
|
|
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 ANTIDEPRESSANTS 6 OR MORE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000098
|
|
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 ANTIDEPRESSANTS OTHER
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000101
|
|
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 ANTIDEPRESSANTS OTHER
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000101
|
|
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 ANTI-DNASE B TITER SERUM
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 86215
|
| Hospital Charge Code |
30001002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$231.26
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
OS ANTI-DNASE B TITER SERUM
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 86215
|
| Hospital Charge Code |
30001002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$231.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
OS ANTIEPILEPTICS OTHER 7/MORE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80341
|
| Hospital Charge Code |
30000103
|
|
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 ANTIEPILEPTICS OTHER 7/MORE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000103
|
|
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 ANTIEPILEPTICS OTHER 7/MORE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000103
|
|
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
|
|
