|
OS BCR/ABL1 MUTATION, SEQUENCI
|
Facility
|
OP
|
$577.60
|
|
|
Service Code
|
HCPCS 81170
|
| Hospital Charge Code |
30002062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.09 |
| Max. Negotiated Rate |
$554.50 |
| Rate for Payer: Aetna Commercial |
$444.75
|
| Rate for Payer: Anthem Medicaid |
$300.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$300.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$463.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$420.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$300.00
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cigna Commercial |
$479.41
|
| Rate for Payer: First Health Commercial |
$548.72
|
| Rate for Payer: Humana Commercial |
$490.96
|
| Rate for Payer: Humana KY Medicaid |
$300.00
|
| Rate for Payer: Humana Medicare Advantage |
$300.00
|
| Rate for Payer: Kentucky WC Medicaid |
$303.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$473.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$426.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$508.29
|
| Rate for Payer: Ohio Health Group HMO |
$433.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.06
|
| Rate for Payer: PHCS Commercial |
$554.50
|
| Rate for Payer: United Healthcare All Payer |
$508.29
|
|
|
OS BCR/ABL1 MUTATION, SEQUENCI
|
Facility
|
IP
|
$577.60
|
|
|
Service Code
|
HCPCS 81170
|
| Hospital Charge Code |
30002062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.09 |
| Max. Negotiated Rate |
$554.50 |
| Rate for Payer: Aetna Commercial |
$444.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$463.81
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cigna Commercial |
$479.41
|
| Rate for Payer: First Health Commercial |
$548.72
|
| Rate for Payer: Humana Commercial |
$490.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$473.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$426.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$508.29
|
| Rate for Payer: Ohio Health Group HMO |
$433.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.06
|
| Rate for Payer: PHCS Commercial |
$554.50
|
| Rate for Payer: United Healthcare All Payer |
$508.29
|
|
|
OS BCR/ABL1 p190 GENE MINOR BP
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 81207
|
| Hospital Charge Code |
30001852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$393.60 |
| Rate for Payer: Aetna Commercial |
$315.70
|
| Rate for Payer: Anthem Medicaid |
$144.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$144.84
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$340.30
|
| Rate for Payer: First Health Commercial |
$389.50
|
| Rate for Payer: Humana Commercial |
$348.50
|
| Rate for Payer: Humana KY Medicaid |
$144.84
|
| Rate for Payer: Humana Medicare Advantage |
$144.84
|
| Rate for Payer: Kentucky WC Medicaid |
$146.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$336.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$302.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$360.80
|
| Rate for Payer: Ohio Health Group HMO |
$307.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.10
|
| Rate for Payer: PHCS Commercial |
$393.60
|
| Rate for Payer: United Healthcare All Payer |
$360.80
|
|
|
OS BCR/ABL1 p190 GENE MINOR BP
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 81207
|
| Hospital Charge Code |
30001852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$393.60 |
| Rate for Payer: Aetna Commercial |
$315.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.23
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$340.30
|
| Rate for Payer: First Health Commercial |
$389.50
|
| Rate for Payer: Humana Commercial |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$336.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$302.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$360.80
|
| Rate for Payer: Ohio Health Group HMO |
$307.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.10
|
| Rate for Payer: PHCS Commercial |
$393.60
|
| Rate for Payer: United Healthcare All Payer |
$360.80
|
|
|
OS BCR/ABL P210 QUNT MON CML
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
30000180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.64 |
| Max. Negotiated Rate |
$698.88 |
| Rate for Payer: Aetna Commercial |
$560.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$584.58
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cigna Commercial |
$604.24
|
| Rate for Payer: First Health Commercial |
$691.60
|
| Rate for Payer: Humana Commercial |
$618.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$596.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$537.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$218.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$640.64
|
| Rate for Payer: Ohio Health Group HMO |
$546.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.68
|
| Rate for Payer: PHCS Commercial |
$698.88
|
| Rate for Payer: United Healthcare All Payer |
$640.64
|
|
|
OS BCR/ABL P210 QUNT MON CML
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
30000180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.64 |
| Max. Negotiated Rate |
$698.88 |
| Rate for Payer: Aetna Commercial |
$560.56
|
| Rate for Payer: Anthem Medicaid |
$163.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$163.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$584.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$229.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.96
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cigna Commercial |
$604.24
|
| Rate for Payer: First Health Commercial |
$691.60
|
| Rate for Payer: Humana Commercial |
$618.80
|
| Rate for Payer: Humana KY Medicaid |
$163.96
|
| Rate for Payer: Humana Medicare Advantage |
$163.96
|
| Rate for Payer: Kentucky WC Medicaid |
$165.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$596.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$537.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$640.64
|
| Rate for Payer: Ohio Health Group HMO |
$546.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.68
|
| Rate for Payer: PHCS Commercial |
$698.88
|
| Rate for Payer: United Healthcare All Payer |
$640.64
|
|
|
OS BCR/ABL P210 QUNT MON CML R
|
Facility
|
IP
|
$722.00
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
30002042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$93.86 |
| Max. Negotiated Rate |
$693.12 |
| Rate for Payer: Aetna Commercial |
$555.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$579.77
|
| Rate for Payer: Cash Price |
$361.00
|
| Rate for Payer: Cigna Commercial |
$599.26
|
| Rate for Payer: First Health Commercial |
$685.90
|
| Rate for Payer: Humana Commercial |
$613.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$592.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$532.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$635.36
|
| Rate for Payer: Ohio Health Group HMO |
$541.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.82
|
| Rate for Payer: PHCS Commercial |
$693.12
|
| Rate for Payer: United Healthcare All Payer |
$635.36
|
|
|
OS BCR/ABL P210 QUNT MON CML R
|
Facility
|
OP
|
$722.00
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
30002042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$93.86 |
| Max. Negotiated Rate |
$693.12 |
| Rate for Payer: Aetna Commercial |
$555.94
|
| Rate for Payer: Anthem Medicaid |
$163.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$163.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$579.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$229.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.96
|
| Rate for Payer: Cash Price |
$361.00
|
| Rate for Payer: Cash Price |
$361.00
|
| Rate for Payer: Cigna Commercial |
$599.26
|
| Rate for Payer: First Health Commercial |
$685.90
|
| Rate for Payer: Humana Commercial |
$613.70
|
| Rate for Payer: Humana KY Medicaid |
$163.96
|
| Rate for Payer: Humana Medicare Advantage |
$163.96
|
| Rate for Payer: Kentucky WC Medicaid |
$165.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$592.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$532.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$635.36
|
| Rate for Payer: Ohio Health Group HMO |
$541.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.82
|
| Rate for Payer: PHCS Commercial |
$693.12
|
| Rate for Payer: United Healthcare All Payer |
$635.36
|
|
|
OS BEEF IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000843
|
|
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 BEEF IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000843
|
|
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 BEETS (BEETROOT) IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000963
|
|
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 BEETS (BEETROOT) IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000963
|
|
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 BENZODIAZEPINE CONF
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
OS BENZODIAZEPINE CONF
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| 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 |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
OS BENZODIAZEPINES13
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$46.50
|
| 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: 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 |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| 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
|
|
|
OS BENZODIAZEPINES13
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000115
|
|
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
|
|
|
OS BENZODIAZEPINES MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000111
|
|
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 BENZODIAZEPINES MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000111
|
|
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 BENZODIAZEPINES URINE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 80347
|
| Hospital Charge Code |
30000113
|
|
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 BENZODIAZEPINES URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000113
|
|
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 BENZODIAZEPINES URINE
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000113
|
|
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 BERLIN BEETLE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000810
|
|
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 BERLIN BEETLE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000810
|
|
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 BERYLLIUM
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
30000359
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$21.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.96
|
| 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 |
$21.96
|
| Rate for Payer: Humana Medicare Advantage |
$21.96
|
| Rate for Payer: Kentucky WC Medicaid |
$22.18
|
| 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 |
$26.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.40
|
| 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 BERYLLIUM
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 83018
|
| Hospital Charge Code |
30000359
|
|
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
|
|
