|
OS CAMOMILE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000904
|
|
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 CAMOMILE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000904
|
|
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 CANARY FEATHERS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000769
|
|
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 CANARY FEATHERS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000769
|
|
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 CANARY GRASS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000814
|
|
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 CANARY GRASS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000814
|
|
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 CANCER ANTIGEN 125
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
30001040
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem Medicaid |
$20.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| Rate for Payer: Humana KY Medicaid |
$20.81
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Kentucky WC Medicaid |
$21.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.22
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
|
OS CANCER ANTIGEN 125
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
30001040
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.09
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.22
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
|
OS CANCER ANTIGEN 15-3
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
30001037
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.45
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
OS CANCER ANTIGEN 15-3
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
30001037
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$20.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$20.81
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Kentucky WC Medicaid |
$21.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
OS CANCER ANTIGEN 19-9
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
30001039
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem Medicaid |
$20.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| Rate for Payer: Humana KY Medicaid |
$20.81
|
| Rate for Payer: Humana Medicare Advantage |
$20.81
|
| Rate for Payer: Kentucky WC Medicaid |
$21.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.22
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
|
OS CANCER ANTIGEN 19-9
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
30001039
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Aetna Commercial |
$124.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.09
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$134.46
|
| Rate for Payer: First Health Commercial |
$153.90
|
| Rate for Payer: Humana Commercial |
$137.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$142.56
|
| Rate for Payer: Ohio Health Group HMO |
$121.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.22
|
| Rate for Payer: PHCS Commercial |
$155.52
|
| Rate for Payer: United Healthcare All Payer |
$142.56
|
|
|
OS CARAWAY IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000806
|
|
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 CARAWAY IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000806
|
|
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 CARBAMAZEPINE FREE
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 80157
|
| Hospital Charge Code |
30000022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.26
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.35
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
OS CARBAMAZEPINE FREE
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 80157
|
| Hospital Charge Code |
30000022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.35
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
OS CARBAMAZEPINE TOTAL
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 80156
|
| Hospital Charge Code |
30000020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$14.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.57
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$14.57
|
| Rate for Payer: Humana Medicare Advantage |
$14.57
|
| Rate for Payer: Kentucky WC Medicaid |
$14.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.35
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
OS CARBAMAZEPINE TOTAL
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 80156
|
| Hospital Charge Code |
30000020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.26
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.35
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
OS CARCINOEMBRYONIC ANTIGEN
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
30000265
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem Medicaid |
$18.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.96
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Humana KY Medicaid |
$18.96
|
| Rate for Payer: Humana Medicare Advantage |
$18.96
|
| Rate for Payer: Kentucky WC Medicaid |
$19.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.82
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
OS CARCINOEMBRYONIC ANTIGEN
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
30000265
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.82
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
OS CARDIOLIPIN ANTIBODIES IGA
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
30000986
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.81
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
OS CARDIOLIPIN ANTIBODIES IGA
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
30000986
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| 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 |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.81
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
OS CARDIOLIPIN ANTIBODIES IGG
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
30000985
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.81
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
OS CARDIOLIPIN ANTIBODIES IGG
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
30000985
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| 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 |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.81
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
OS CARDIOLIPIN ANTIBODIES IGM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
30000987
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| 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 |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.81
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
