OS AUTOANTIBODIES TO SSA/RO S
|
Facility
|
IP
|
$175.00
|
|
Service Code
|
HCPCS 86235
|
Hospital Charge Code |
30001008
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$22.75 |
Max. Negotiated Rate |
$168.00 |
Rate for Payer: Aetna Commercial |
$134.75
|
Rate for Payer: Anthem POS/PPO/Traditional |
$140.52
|
Rate for Payer: Cash Price |
$87.50
|
Rate for Payer: Cigna Commercial |
$145.25
|
Rate for Payer: First Health Commercial |
$166.25
|
Rate for Payer: Humana Commercial |
$148.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
Rate for Payer: Ohio Health Group HMO |
$131.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
Rate for Payer: PHCS Commercial |
$168.00
|
Rate for Payer: United Healthcare All Payer |
$154.00
|
|
OS AUTOANTIBODIES TO SSA/RO S
|
Facility
|
OP
|
$175.00
|
|
Service Code
|
HCPCS 86235
|
Hospital Charge Code |
30001008
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$17.93 |
Max. Negotiated Rate |
$168.00 |
Rate for Payer: Aetna Commercial |
$134.75
|
Rate for Payer: Anthem Medicaid |
$17.93
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$17.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$140.52
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.10
|
Rate for Payer: CareSource Just4Me Medicare |
$17.93
|
Rate for Payer: Cash Price |
$87.50
|
Rate for Payer: Cash Price |
$87.50
|
Rate for Payer: Cigna Commercial |
$145.25
|
Rate for Payer: First Health Commercial |
$166.25
|
Rate for Payer: Humana Commercial |
$148.75
|
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 |
$143.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
Rate for Payer: Molina Healthcare Medicaid |
$18.29
|
Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
Rate for Payer: Ohio Health Group HMO |
$131.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
Rate for Payer: PHCS Commercial |
$168.00
|
Rate for Payer: United Healthcare All Payer |
$154.00
|
|
OS AUTOANTIBODIES TO SSB/LA S
|
Facility
|
OP
|
$175.00
|
|
Service Code
|
HCPCS 86235
|
Hospital Charge Code |
30001009
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$17.93 |
Max. Negotiated Rate |
$168.00 |
Rate for Payer: Aetna Commercial |
$134.75
|
Rate for Payer: Anthem Medicaid |
$17.93
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$17.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$140.52
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.10
|
Rate for Payer: CareSource Just4Me Medicare |
$17.93
|
Rate for Payer: Cash Price |
$87.50
|
Rate for Payer: Cash Price |
$87.50
|
Rate for Payer: Cigna Commercial |
$145.25
|
Rate for Payer: First Health Commercial |
$166.25
|
Rate for Payer: Humana Commercial |
$148.75
|
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 |
$143.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
Rate for Payer: Molina Healthcare Medicaid |
$18.29
|
Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
Rate for Payer: Ohio Health Group HMO |
$131.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
Rate for Payer: PHCS Commercial |
$168.00
|
Rate for Payer: United Healthcare All Payer |
$154.00
|
|
OS AUTOANTIBODIES TO SSB/LA S
|
Facility
|
IP
|
$175.00
|
|
Service Code
|
HCPCS 86235
|
Hospital Charge Code |
30001009
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$22.75 |
Max. Negotiated Rate |
$168.00 |
Rate for Payer: Aetna Commercial |
$134.75
|
Rate for Payer: Anthem POS/PPO/Traditional |
$140.52
|
Rate for Payer: Cash Price |
$87.50
|
Rate for Payer: Cigna Commercial |
$145.25
|
Rate for Payer: First Health Commercial |
$166.25
|
Rate for Payer: Humana Commercial |
$148.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
Rate for Payer: Ohio Health Group HMO |
$131.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
Rate for Payer: PHCS Commercial |
$168.00
|
Rate for Payer: United Healthcare All Payer |
$154.00
|
|
OS AUTOANTIBODIES TO U RNP S
|
Facility
|
IP
|
$193.00
|
|
Service Code
|
HCPCS 86235
|
Hospital Charge Code |
30001006
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$25.09 |
Max. Negotiated Rate |
$185.28 |
Rate for Payer: Aetna Commercial |
$148.61
|
Rate for Payer: Anthem POS/PPO/Traditional |
$154.98
|
Rate for Payer: Cash Price |
$96.50
|
Rate for Payer: Cigna Commercial |
$160.19
|
Rate for Payer: First Health Commercial |
$183.35
|
Rate for Payer: Humana Commercial |
$164.05
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$158.26
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$142.43
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$57.90
|
Rate for Payer: Ohio Health Choice Commercial |
$169.84
|
Rate for Payer: Ohio Health Group HMO |
$144.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$38.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$25.09
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.83
|
Rate for Payer: PHCS Commercial |
$185.28
|
Rate for Payer: United Healthcare All Payer |
$169.84
|
|
OS AUTOANTIBODIES TO U RNP S
|
Facility
|
OP
|
$193.00
|
|
Service Code
|
HCPCS 86235
|
Hospital Charge Code |
30001006
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$17.93 |
Max. Negotiated Rate |
$185.28 |
Rate for Payer: Aetna Commercial |
$148.61
|
Rate for Payer: Anthem Medicaid |
$17.93
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$17.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$154.98
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.10
|
Rate for Payer: CareSource Just4Me Medicare |
$17.93
|
Rate for Payer: Cash Price |
$96.50
|
Rate for Payer: Cash Price |
$96.50
|
Rate for Payer: Cigna Commercial |
$160.19
|
Rate for Payer: First Health Commercial |
$183.35
|
Rate for Payer: Humana Commercial |
$164.05
|
Rate for Payer: Humana KY Medicaid |
$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 |
$158.26
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$142.43
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$21.52
|
Rate for Payer: Molina Healthcare Medicaid |
$18.29
|
Rate for Payer: Ohio Health Choice Commercial |
$169.84
|
Rate for Payer: Ohio Health Group HMO |
$144.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$38.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$25.09
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.83
|
Rate for Payer: PHCS Commercial |
$185.28
|
Rate for Payer: United Healthcare All Payer |
$169.84
|
|
OS AUTOANTIBOD TO PROTEINA S
|
Facility
|
OP
|
$173.00
|
|
Service Code
|
HCPCS 83516
|
Hospital Charge Code |
30000377
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$11.53 |
Max. Negotiated Rate |
$166.08 |
Rate for Payer: Aetna Commercial |
$133.21
|
Rate for Payer: Anthem Medicaid |
$11.53
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
Rate for Payer: Anthem POS/PPO/Traditional |
$138.92
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
Rate for Payer: Cash Price |
$86.50
|
Rate for Payer: Cash Price |
$86.50
|
Rate for Payer: Cigna Commercial |
$143.59
|
Rate for Payer: First Health Commercial |
$164.35
|
Rate for Payer: Humana Commercial |
$147.05
|
Rate for Payer: Humana KY Medicaid |
$11.53
|
Rate for Payer: Humana Medicare Advantage |
$11.53
|
Rate for Payer: Kentucky WC Medicaid |
$11.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$141.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$127.67
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
Rate for Payer: Ohio Health Choice Commercial |
$152.24
|
Rate for Payer: Ohio Health Group HMO |
$129.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$34.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$22.49
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.63
|
Rate for Payer: PHCS Commercial |
$166.08
|
Rate for Payer: United Healthcare All Payer |
$152.24
|
|
OS AUTOANTIBOD TO PROTEINA S
|
Facility
|
IP
|
$173.00
|
|
Service Code
|
HCPCS 83516
|
Hospital Charge Code |
30000377
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$22.49 |
Max. Negotiated Rate |
$166.08 |
Rate for Payer: Aetna Commercial |
$133.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$138.92
|
Rate for Payer: Cash Price |
$86.50
|
Rate for Payer: Cigna Commercial |
$143.59
|
Rate for Payer: First Health Commercial |
$164.35
|
Rate for Payer: Humana Commercial |
$147.05
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$141.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$127.67
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$51.90
|
Rate for Payer: Ohio Health Choice Commercial |
$152.24
|
Rate for Payer: Ohio Health Group HMO |
$129.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$34.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$22.49
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.63
|
Rate for Payer: PHCS Commercial |
$166.08
|
Rate for Payer: United Healthcare All Payer |
$152.24
|
|
OS AVOCADO IGE
|
Facility
|
IP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000701
|
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 AVOCADO IGE
|
Facility
|
OP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000701
|
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 BABESIA MICROTI IGA AB S
|
Facility
|
IP
|
$143.00
|
|
Service Code
|
HCPCS 86753
|
Hospital Charge Code |
30001201
|
Hospital Revenue Code
|
300
|
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 BABESIA MICROTI IGA AB S
|
Facility
|
OP
|
$143.00
|
|
Service Code
|
HCPCS 86753
|
Hospital Charge Code |
30001201
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$12.39 |
Max. Negotiated Rate |
$137.28 |
Rate for Payer: Aetna Commercial |
$110.11
|
Rate for Payer: Anthem Medicaid |
$12.39
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$12.39
|
Rate for Payer: Anthem POS/PPO/Traditional |
$114.83
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.35
|
Rate for Payer: CareSource Just4Me Medicare |
$12.39
|
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 |
$12.39
|
Rate for Payer: Humana Medicare Advantage |
$12.39
|
Rate for Payer: Kentucky WC Medicaid |
$12.51
|
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 |
$14.87
|
Rate for Payer: Molina Healthcare Medicaid |
$12.64
|
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 BAHIA GRASS IGE
|
Facility
|
IP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000882
|
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 BAHIA GRASS IGE
|
Facility
|
OP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000882
|
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 BAKER'S YEAST IGE
|
Facility
|
IP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000752
|
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 BAKER'S YEAST IGE
|
Facility
|
OP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000752
|
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 BALD CYPRESS IGE
|
Facility
|
IP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000704
|
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 BALD CYPRESS IGE
|
Facility
|
OP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000704
|
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 BAMBOO SHOOT IGE
|
Facility
|
IP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000826
|
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 BAMBOO SHOOT IGE
|
Facility
|
OP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000826
|
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 BANANA IGE
|
Facility
|
IP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000760
|
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 BANANA IGE
|
Facility
|
OP
|
$65.00
|
|
Service Code
|
HCPCS 86003
|
Hospital Charge Code |
30000760
|
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 BARBITURATE CONF. URINE
|
Facility
|
OP
|
$145.00
|
|
Service Code
|
HCPCS G0480
|
Hospital Charge Code |
30000109
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$18.85 |
Max. Negotiated Rate |
$160.20 |
Rate for Payer: Aetna Commercial |
$111.65
|
Rate for Payer: Anthem Medicaid |
$114.43
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$116.44
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
Rate for Payer: Cash Price |
$72.50
|
Rate for Payer: Cash Price |
$72.50
|
Rate for Payer: Cigna Commercial |
$120.35
|
Rate for Payer: First Health Commercial |
$137.75
|
Rate for Payer: Humana Commercial |
$123.25
|
Rate for Payer: Humana KY Medicaid |
$114.43
|
Rate for Payer: Humana Medicare Advantage |
$114.43
|
Rate for Payer: Kentucky WC Medicaid |
$115.57
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
Rate for Payer: Ohio Health Group HMO |
$108.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$29.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$18.85
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.95
|
Rate for Payer: PHCS Commercial |
$139.20
|
Rate for Payer: United Healthcare All Payer |
$127.60
|
|
OS BARBITURATE CONF. URINE
|
Facility
|
IP
|
$145.00
|
|
Service Code
|
HCPCS G0480
|
Hospital Charge Code |
30000109
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$18.85 |
Max. Negotiated Rate |
$139.20 |
Rate for Payer: Aetna Commercial |
$111.65
|
Rate for Payer: Anthem POS/PPO/Traditional |
$116.44
|
Rate for Payer: Cash Price |
$72.50
|
Rate for Payer: Cigna Commercial |
$120.35
|
Rate for Payer: First Health Commercial |
$137.75
|
Rate for Payer: Humana Commercial |
$123.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$118.90
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.01
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$43.50
|
Rate for Payer: Ohio Health Choice Commercial |
$127.60
|
Rate for Payer: Ohio Health Group HMO |
$108.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$29.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$18.85
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.95
|
Rate for Payer: PHCS Commercial |
$139.20
|
Rate for Payer: United Healthcare All Payer |
$127.60
|
|
OS BARBITURATES CONFIRMATION
|
Facility
|
IP
|
$93.00
|
|
Service Code
|
HCPCS G0480
|
Hospital Charge Code |
30000108
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$12.09 |
Max. Negotiated Rate |
$89.28 |
Rate for Payer: Aetna Commercial |
$71.61
|
Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
Rate for Payer: Cash Price |
$46.50
|
Rate for Payer: Cigna Commercial |
$77.19
|
Rate for Payer: First Health Commercial |
$88.35
|
Rate for Payer: Humana Commercial |
$79.05
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
Rate for Payer: Ohio Health Group HMO |
$69.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
Rate for Payer: PHCS Commercial |
$89.28
|
Rate for Payer: United Healthcare All Payer |
$81.84
|
|