|
OS ANTISTREP O ASO TITER QUANT
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
30000978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.33 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna Commercial |
$185.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$193.52
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$200.03
|
| Rate for Payer: First Health Commercial |
$228.95
|
| Rate for Payer: Humana Commercial |
$204.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$197.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.08
|
| Rate for Payer: Ohio Health Group HMO |
$180.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.71
|
| Rate for Payer: PHCS Commercial |
$231.36
|
| Rate for Payer: United Healthcare All Payer |
$212.08
|
|
|
OS ANTISTREP O ASO TITER QUANT
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
30000978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna Commercial |
$185.57
|
| Rate for Payer: Anthem Medicaid |
$7.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$193.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.30
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$200.03
|
| Rate for Payer: First Health Commercial |
$228.95
|
| Rate for Payer: Humana Commercial |
$204.85
|
| Rate for Payer: Humana KY Medicaid |
$7.30
|
| Rate for Payer: Humana Medicare Advantage |
$7.30
|
| Rate for Payer: Kentucky WC Medicaid |
$7.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$197.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.08
|
| Rate for Payer: Ohio Health Group HMO |
$180.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.71
|
| Rate for Payer: PHCS Commercial |
$231.36
|
| Rate for Payer: United Healthcare All Payer |
$212.08
|
|
|
OS ANTITHROMBIN III ABP
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
30000589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$254.40 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Anthem Medicaid |
$10.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.81
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$219.95
|
| Rate for Payer: First Health Commercial |
$251.75
|
| Rate for Payer: Humana Commercial |
$225.25
|
| Rate for Payer: Humana KY Medicaid |
$10.81
|
| Rate for Payer: Humana Medicare Advantage |
$10.81
|
| Rate for Payer: Kentucky WC Medicaid |
$10.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$217.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$195.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$233.20
|
| Rate for Payer: Ohio Health Group HMO |
$198.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.15
|
| Rate for Payer: PHCS Commercial |
$254.40
|
| Rate for Payer: United Healthcare All Payer |
$233.20
|
|
|
OS ANTITHROMBIN III ABP
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
30000589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.45 |
| Max. Negotiated Rate |
$254.40 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.80
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$219.95
|
| Rate for Payer: First Health Commercial |
$251.75
|
| Rate for Payer: Humana Commercial |
$225.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$217.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$195.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$233.20
|
| Rate for Payer: Ohio Health Group HMO |
$198.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.15
|
| Rate for Payer: PHCS Commercial |
$254.40
|
| Rate for Payer: United Healthcare All Payer |
$233.20
|
|
|
OS ANTITHROMBIN III ACTIVITY
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
30000588
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$11.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.85
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$11.85
|
| Rate for Payer: Humana Medicare Advantage |
$11.85
|
| Rate for Payer: Kentucky WC Medicaid |
$11.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS ANTITHROMBIN III ACTIVITY
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
30000588
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS APOLIPROPROTEIN EACH
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
30000241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
OS APOLIPROPROTEIN EACH
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
30000241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem Medicaid |
$21.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.09
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Humana KY Medicaid |
$21.09
|
| Rate for Payer: Humana Medicare Advantage |
$21.09
|
| Rate for Payer: Kentucky WC Medicaid |
$21.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.96
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
OS APPLE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000842
|
|
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 APPLE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000842
|
|
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 APRICOT IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000948
|
|
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 APRICOT IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000948
|
|
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 APTT MIX 1:1
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
30000633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS APTT MIX 1:1
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
30000633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem Medicaid |
$6.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Humana KY Medicaid |
$6.47
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Kentucky WC Medicaid |
$6.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS AQAPRN-4 ANTB FLOCYTMTRY EA
|
Facility
|
IP
|
$525.09
|
|
|
Service Code
|
HCPCS 86053
|
| Hospital Charge Code |
30002015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.26 |
| Max. Negotiated Rate |
$504.09 |
| Rate for Payer: Aetna Commercial |
$404.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.65
|
| Rate for Payer: Cash Price |
$262.54
|
| Rate for Payer: Cigna Commercial |
$435.82
|
| Rate for Payer: First Health Commercial |
$498.84
|
| Rate for Payer: Humana Commercial |
$446.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.08
|
| Rate for Payer: Ohio Health Group HMO |
$393.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.78
|
| Rate for Payer: PHCS Commercial |
$504.09
|
| Rate for Payer: United Healthcare All Payer |
$462.08
|
|
|
OS AQAPRN-4 ANTB FLOCYTMTRY EA
|
Facility
|
OP
|
$525.09
|
|
|
Service Code
|
HCPCS 86053
|
| Hospital Charge Code |
30002015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$504.09 |
| Rate for Payer: Aetna Commercial |
$404.32
|
| Rate for Payer: Anthem Medicaid |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$52.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.73
|
| Rate for Payer: Cash Price |
$262.54
|
| Rate for Payer: Cash Price |
$262.54
|
| Rate for Payer: Cigna Commercial |
$435.82
|
| Rate for Payer: First Health Commercial |
$498.84
|
| Rate for Payer: Humana Commercial |
$446.33
|
| Rate for Payer: Humana KY Medicaid |
$37.73
|
| Rate for Payer: Humana Medicare Advantage |
$37.73
|
| Rate for Payer: Kentucky WC Medicaid |
$38.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.08
|
| Rate for Payer: Ohio Health Group HMO |
$393.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.78
|
| Rate for Payer: PHCS Commercial |
$504.09
|
| Rate for Payer: United Healthcare All Payer |
$462.08
|
|
|
OS ARGININE VASOPRESSIN
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
30000555
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$151.68 |
| Rate for Payer: Aetna Commercial |
$121.66
|
| Rate for Payer: Anthem Medicaid |
$33.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$33.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$47.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.94
|
| Rate for Payer: Cash Price |
$79.00
|
| Rate for Payer: Cash Price |
$79.00
|
| Rate for Payer: Cigna Commercial |
$131.14
|
| Rate for Payer: First Health Commercial |
$150.10
|
| Rate for Payer: Humana Commercial |
$134.30
|
| Rate for Payer: Humana KY Medicaid |
$33.94
|
| Rate for Payer: Humana Medicare Advantage |
$33.94
|
| Rate for Payer: Kentucky WC Medicaid |
$34.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$129.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.04
|
| Rate for Payer: Ohio Health Group HMO |
$118.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.98
|
| Rate for Payer: PHCS Commercial |
$151.68
|
| Rate for Payer: United Healthcare All Payer |
$139.04
|
|
|
OS ARGININE VASOPRESSIN
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
30000555
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$151.68 |
| Rate for Payer: Aetna Commercial |
$121.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.87
|
| Rate for Payer: Cash Price |
$79.00
|
| Rate for Payer: Cigna Commercial |
$131.14
|
| Rate for Payer: First Health Commercial |
$150.10
|
| Rate for Payer: Humana Commercial |
$134.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$129.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$116.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$139.04
|
| Rate for Payer: Ohio Health Group HMO |
$118.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.98
|
| Rate for Payer: PHCS Commercial |
$151.68
|
| Rate for Payer: United Healthcare All Payer |
$139.04
|
|
|
OS ARSENIC URINE
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
30000242
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$133.44 |
| Rate for Payer: Aetna Commercial |
$107.03
|
| Rate for Payer: Anthem Medicaid |
$18.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$111.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.97
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$115.37
|
| Rate for Payer: First Health Commercial |
$132.05
|
| Rate for Payer: Humana Commercial |
$118.15
|
| Rate for Payer: Humana KY Medicaid |
$18.97
|
| Rate for Payer: Humana Medicare Advantage |
$18.97
|
| Rate for Payer: Kentucky WC Medicaid |
$19.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.32
|
| Rate for Payer: Ohio Health Group HMO |
$104.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.09
|
| Rate for Payer: PHCS Commercial |
$133.44
|
| Rate for Payer: United Healthcare All Payer |
$122.32
|
|
|
OS ARSENIC URINE
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
30000242
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$133.44 |
| Rate for Payer: Aetna Commercial |
$107.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$111.62
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$115.37
|
| Rate for Payer: First Health Commercial |
$132.05
|
| Rate for Payer: Humana Commercial |
$118.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.32
|
| Rate for Payer: Ohio Health Group HMO |
$104.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.09
|
| Rate for Payer: PHCS Commercial |
$133.44
|
| Rate for Payer: United Healthcare All Payer |
$122.32
|
|
|
OS ASCA IGA
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000404
|
|
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 ASCA IGA
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000404
|
|
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 ASCA IGG
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| 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 |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.85
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
OS ASCA IGG
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.10
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.85
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
OS ASCARIS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000874
|
|
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
|
|
