|
OS BETA 2 GP1 AB IGA S
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
30000982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$25.45
|
| Rate for Payer: Humana Medicare Advantage |
$25.45
|
| Rate for Payer: Kentucky WC Medicaid |
$25.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
OS BETA 2 GP1 AB IGA S
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
30000982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.56
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
OS BETA 2 GP1 AB IGG S
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
30000983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Humana KY Medicaid |
$25.45
|
| Rate for Payer: Humana Medicare Advantage |
$25.45
|
| Rate for Payer: Kentucky WC Medicaid |
$25.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.75
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
OS BETA 2 GP1 AB IGG S
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
30000983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.38
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.75
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
OS BETA 2 GP1 AB IGM S
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
30000984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.38
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.75
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
OS BETA 2 GP1 AB IGM S
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
30000984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Humana KY Medicaid |
$25.45
|
| Rate for Payer: Humana Medicare Advantage |
$25.45
|
| Rate for Payer: Kentucky WC Medicaid |
$25.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.75
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
OS BETA 2 MICROLOBULIN S
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 82232
|
| Hospital Charge Code |
30000244
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.34
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.11
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
OS BETA 2 MICROLOBULIN S
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 82232
|
| Hospital Charge Code |
30000244
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem Medicaid |
$16.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.18
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Humana KY Medicaid |
$16.18
|
| Rate for Payer: Humana Medicare Advantage |
$16.18
|
| Rate for Payer: Kentucky WC Medicaid |
$16.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.11
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
OS BETA GLOBIN GENE DEL/DUP
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 81403
|
| Hospital Charge Code |
30000206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.74
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
OS BETA GLOBIN GENE DEL/DUP
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 81403
|
| Hospital Charge Code |
30000206
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$259.28 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$185.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$259.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$185.20
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$185.20
|
| Rate for Payer: Humana Medicare Advantage |
$185.20
|
| Rate for Payer: Kentucky WC Medicaid |
$187.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
OS BETA-HYDROXYBUTYRATE
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
30000220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.17
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$8.17
|
| Rate for Payer: Humana Medicare Advantage |
$8.17
|
| Rate for Payer: Kentucky WC Medicaid |
$8.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.66
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
OS BETA-HYDROXYBUTYRATE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
30000220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.66
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
OS BETHESDA UNITS
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
30000597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem Medicaid |
$12.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.87
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Humana KY Medicaid |
$12.87
|
| Rate for Payer: Humana Medicare Advantage |
$12.87
|
| Rate for Payer: Kentucky WC Medicaid |
$13.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.71
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
OS BETHESDA UNITS
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
30000597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.33 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.82
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.71
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
OS B GARINII B AFZELII PCR
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001395
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$262.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Multiplan PHCS |
$157.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$183.40
|
| Rate for Payer: UHCCP Medicaid |
$91.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
|
|
OS B GARINII B AFZELII PCR
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001395
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$251.52 |
| Rate for Payer: Aetna Commercial |
$201.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$210.39
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$217.46
|
| Rate for Payer: First Health Commercial |
$248.90
|
| Rate for Payer: Humana Commercial |
$222.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$193.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$230.56
|
| Rate for Payer: Ohio Health Group HMO |
$196.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.22
|
| Rate for Payer: PHCS Commercial |
$251.52
|
| Rate for Payer: United Healthcare All Payer |
$230.56
|
|
|
OS B GARINII B AFZELII PCR
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001395
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$251.52 |
| Rate for Payer: Aetna Commercial |
$201.74
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$210.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$217.46
|
| Rate for Payer: First Health Commercial |
$248.90
|
| Rate for Payer: Humana Commercial |
$222.70
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$193.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$230.56
|
| Rate for Payer: Ohio Health Group HMO |
$196.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.22
|
| Rate for Payer: PHCS Commercial |
$251.52
|
| Rate for Payer: United Healthcare All Payer |
$230.56
|
|
|
OS BILE ACIDS S
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 82239
|
| Hospital Charge Code |
30000245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.48
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.14
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
OS BILE ACIDS S
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 82239
|
| Hospital Charge Code |
30000245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem Medicaid |
$17.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.12
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Humana KY Medicaid |
$17.12
|
| Rate for Payer: Humana Medicare Advantage |
$17.12
|
| Rate for Payer: Kentucky WC Medicaid |
$17.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.14
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
OS BILIRUBIN TOTAL
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
30000247
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
OS BILIRUBIN TOTAL
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
30000247
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$5.02
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
OS BIOTINIDASE
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 82261
|
| Hospital Charge Code |
30001856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$16.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.87
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Humana KY Medicaid |
$16.87
|
| Rate for Payer: Humana Medicare Advantage |
$16.87
|
| Rate for Payer: Kentucky WC Medicaid |
$17.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.34
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
OS BIOTINIDASE
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 82261
|
| Hospital Charge Code |
30001856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.34
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
OS BLACKBERRY IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000641
|
|
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 BLACKBERRY IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000641
|
|
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
|
|
