|
OS ANTI FLA X
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000399
|
|
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 FLA X
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000399
|
|
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-Golimumab Antibody
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30001896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.18
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
OS Anti-Golimumab Antibody
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 82397
|
| Hospital Charge Code |
30001896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$14.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.12
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Humana KY Medicaid |
$14.12
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Kentucky WC Medicaid |
$14.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
OS ANTIHISTONE AB
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
30000380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem Medicaid |
$17.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Humana KY Medicaid |
$17.93
|
| Rate for Payer: Humana Medicare Advantage |
$17.93
|
| Rate for Payer: Kentucky WC Medicaid |
$18.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
OS ANTIHISTONE AB
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
30000380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.33
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
OS ANTI I2
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000419
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna Commercial |
$23.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.89
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna Commercial |
$25.73
|
| Rate for Payer: First Health Commercial |
$29.45
|
| Rate for Payer: Humana Commercial |
$26.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.28
|
| Rate for Payer: Ohio Health Group HMO |
$23.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.61
|
| Rate for Payer: PHCS Commercial |
$29.76
|
| Rate for Payer: United Healthcare All Payer |
$27.28
|
|
|
OS ANTI I2
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000419
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna Commercial |
$23.87
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna Commercial |
$25.73
|
| Rate for Payer: First Health Commercial |
$29.45
|
| Rate for Payer: Humana Commercial |
$26.35
|
| 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 |
$25.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.28
|
| Rate for Payer: Ohio Health Group HMO |
$23.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.61
|
| Rate for Payer: PHCS Commercial |
$29.76
|
| Rate for Payer: United Healthcare All Payer |
$27.28
|
|
|
OS ANTI-MULLERIAN HORMONE
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 82166
|
| Hospital Charge Code |
30000274
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$38.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.62
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$38.62
|
| Rate for Payer: Kentucky WC Medicaid |
$39.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.94
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS ANTI-MULLERIAN HORMONE
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 82166
|
| Hospital Charge Code |
30000274
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.94
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS ANTI OMPC IGA
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna Commercial |
$26.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.30
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cigna Commercial |
$28.22
|
| Rate for Payer: First Health Commercial |
$32.30
|
| Rate for Payer: Humana Commercial |
$28.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.92
|
| Rate for Payer: Ohio Health Group HMO |
$25.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.54
|
| Rate for Payer: PHCS Commercial |
$32.64
|
| Rate for Payer: United Healthcare All Payer |
$29.92
|
|
|
OS ANTI OMPC IGA
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$32.64 |
| Rate for Payer: Aetna Commercial |
$26.18
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cigna Commercial |
$28.22
|
| Rate for Payer: First Health Commercial |
$32.30
|
| Rate for Payer: Humana Commercial |
$28.90
|
| 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 |
$27.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.92
|
| Rate for Payer: Ohio Health Group HMO |
$25.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.54
|
| Rate for Payer: PHCS Commercial |
$32.64
|
| Rate for Payer: United Healthcare All Payer |
$29.92
|
|
|
OS ANTI-PHOSPHOLIPID ANTIBODY
|
Facility
|
IP
|
$296.25
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
30002012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.51 |
| Max. Negotiated Rate |
$284.40 |
| Rate for Payer: Aetna Commercial |
$228.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.89
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cigna Commercial |
$245.89
|
| Rate for Payer: First Health Commercial |
$281.44
|
| Rate for Payer: Humana Commercial |
$251.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.70
|
| Rate for Payer: Ohio Health Group HMO |
$222.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.84
|
| Rate for Payer: PHCS Commercial |
$284.40
|
| Rate for Payer: United Healthcare All Payer |
$260.70
|
|
|
OS ANTI-PHOSPHOLIPID ANTIBODY
|
Facility
|
OP
|
$296.25
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
30002012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$284.40 |
| Rate for Payer: Aetna Commercial |
$228.11
|
| Rate for Payer: Anthem Medicaid |
$16.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.07
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cigna Commercial |
$245.89
|
| Rate for Payer: First Health Commercial |
$281.44
|
| Rate for Payer: Humana Commercial |
$251.81
|
| Rate for Payer: Humana KY Medicaid |
$16.07
|
| Rate for Payer: Humana Medicare Advantage |
$16.07
|
| Rate for Payer: Kentucky WC Medicaid |
$16.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$242.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$218.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$260.70
|
| Rate for Payer: Ohio Health Group HMO |
$222.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.84
|
| Rate for Payer: PHCS Commercial |
$284.40
|
| Rate for Payer: United Healthcare All Payer |
$260.70
|
|
|
OS ANTIPSYCHOTICS MH
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000105
|
|
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 ANTIPSYCHOTICS MH
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000105
|
|
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 ANTIPSYCHOTICS Paliperidone
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS 80342
|
| Hospital Charge Code |
30001991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$213.12 |
| Rate for Payer: Aetna Commercial |
$170.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$178.27
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$184.26
|
| Rate for Payer: First Health Commercial |
$210.90
|
| Rate for Payer: Humana Commercial |
$188.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$195.36
|
| Rate for Payer: Ohio Health Group HMO |
$166.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.82
|
| Rate for Payer: PHCS Commercial |
$213.12
|
| Rate for Payer: United Healthcare All Payer |
$195.36
|
|
|
OS ANTIPSYCHOTICS Paliperidone
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS 80342
|
| Hospital Charge Code |
30001991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$213.12 |
| Rate for Payer: Aetna Commercial |
$170.94
|
| Rate for Payer: Anthem Medicaid |
$76.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$178.27
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$184.26
|
| Rate for Payer: First Health Commercial |
$210.90
|
| Rate for Payer: Humana Commercial |
$188.70
|
| Rate for Payer: Humana KY Medicaid |
$76.35
|
| Rate for Payer: Kentucky WC Medicaid |
$77.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$77.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$195.36
|
| Rate for Payer: Ohio Health Group HMO |
$166.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.82
|
| Rate for Payer: PHCS Commercial |
$213.12
|
| Rate for Payer: United Healthcare All Payer |
$195.36
|
|
|
OS ANTIPSYCOTICSOTHER7 OR MORE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000106
|
|
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 ANTIPSYCOTICSOTHER7 OR MORE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80344
|
| Hospital Charge Code |
30000106
|
|
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 ANTIPSYCOTICSOTHER7 OR MORE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000106
|
|
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 SMOOTH MUSCLE AB TITER
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
30001023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| 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 |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.74
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
OS ANTI SMOOTH MUSCLE AB TITER
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
30001023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.74
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
OS ANTI SMOOT MUSCLE AB SCREN
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
30001015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
OS ANTI SMOOT MUSCLE AB SCREN
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
30001015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| 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 |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
