|
OS EPSTEIN BARR VIRUS CSF PCR
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001398
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.69 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$318.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.64
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$342.79
|
| Rate for Payer: First Health Commercial |
$392.35
|
| Rate for Payer: Humana Commercial |
$351.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$338.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$363.44
|
| Rate for Payer: Ohio Health Group HMO |
$309.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.03
|
| Rate for Payer: PHCS Commercial |
$396.48
|
| Rate for Payer: United Healthcare All Payer |
$363.44
|
|
|
OS EPSTEIN BARR VIRUS CSF PCR
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30001398
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$318.01
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$331.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$342.79
|
| Rate for Payer: First Health Commercial |
$392.35
|
| Rate for Payer: Humana Commercial |
$351.05
|
| 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 |
$338.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$363.44
|
| Rate for Payer: Ohio Health Group HMO |
$309.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.03
|
| Rate for Payer: PHCS Commercial |
$396.48
|
| Rate for Payer: United Healthcare All Payer |
$363.44
|
|
|
OS EPSTEIN BARR VIRUS IGA S
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001152
|
|
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 Medicaid |
$18.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.14
|
| 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 |
$18.14
|
| Rate for Payer: Humana Medicare Advantage |
$18.14
|
| Rate for Payer: Kentucky WC Medicaid |
$18.32
|
| 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 |
$21.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.50
|
| 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 EPSTEIN BARR VIRUS IGA S
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
30001152
|
|
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 EPSTEIN BAR VIRUS PCR QN B
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
30001406
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.28
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.75
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
OS EPSTEIN BAR VIRUS PCR QN B
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
30001406
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Anthem Medicaid |
$42.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.84
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$352.75
|
| Rate for Payer: First Health Commercial |
$403.75
|
| Rate for Payer: Humana Commercial |
$361.25
|
| Rate for Payer: Humana KY Medicaid |
$42.84
|
| Rate for Payer: Humana Medicare Advantage |
$42.84
|
| Rate for Payer: Kentucky WC Medicaid |
$43.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$313.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$374.00
|
| Rate for Payer: Ohio Health Group HMO |
$318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.75
|
| Rate for Payer: PHCS Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Payer |
$374.00
|
|
|
OS ERYTHROPOIETIN SERUM
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 82668
|
| Hospital Charge Code |
30000311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
OS ERYTHROPOIETIN SERUM
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 82668
|
| Hospital Charge Code |
30000311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.79 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$18.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.79
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$18.79
|
| Rate for Payer: Humana Medicare Advantage |
$18.79
|
| Rate for Payer: Kentucky WC Medicaid |
$18.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
OS ESTRIOL UNCONJUGATED
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
30000313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$105.60 |
| Rate for Payer: Aetna Commercial |
$84.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.33
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$91.30
|
| Rate for Payer: First Health Commercial |
$104.50
|
| Rate for Payer: Humana Commercial |
$93.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$90.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$96.80
|
| Rate for Payer: Ohio Health Group HMO |
$82.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.10
|
| Rate for Payer: PHCS Commercial |
$105.60
|
| Rate for Payer: United Healthcare All Payer |
$96.80
|
|
|
OS ESTRIOL UNCONJUGATED
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
30000313
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$105.60 |
| Rate for Payer: Aetna Commercial |
$84.70
|
| Rate for Payer: Anthem Medicaid |
$24.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.18
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$91.30
|
| Rate for Payer: First Health Commercial |
$104.50
|
| Rate for Payer: Humana Commercial |
$93.50
|
| Rate for Payer: Humana KY Medicaid |
$24.18
|
| Rate for Payer: Humana Medicare Advantage |
$24.18
|
| Rate for Payer: Kentucky WC Medicaid |
$24.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$90.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$96.80
|
| Rate for Payer: Ohio Health Group HMO |
$82.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.10
|
| Rate for Payer: PHCS Commercial |
$105.60
|
| Rate for Payer: United Healthcare All Payer |
$96.80
|
|
|
OS ESTRONE SERUM
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 82679
|
| Hospital Charge Code |
30000314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.95 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Anthem Medicaid |
$24.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.95
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$175.96
|
| Rate for Payer: First Health Commercial |
$201.40
|
| Rate for Payer: Humana Commercial |
$180.20
|
| Rate for Payer: Humana KY Medicaid |
$24.95
|
| Rate for Payer: Humana Medicare Advantage |
$24.95
|
| Rate for Payer: Kentucky WC Medicaid |
$25.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.56
|
| Rate for Payer: Ohio Health Group HMO |
$159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.72
|
| Rate for Payer: PHCS Commercial |
$203.52
|
| Rate for Payer: United Healthcare All Payer |
$186.56
|
|
|
OS ESTRONE SERUM
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 82679
|
| Hospital Charge Code |
30000314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.24
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$175.96
|
| Rate for Payer: First Health Commercial |
$201.40
|
| Rate for Payer: Humana Commercial |
$180.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.56
|
| Rate for Payer: Ohio Health Group HMO |
$159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.72
|
| Rate for Payer: PHCS Commercial |
$203.52
|
| Rate for Payer: United Healthcare All Payer |
$186.56
|
|
|
OS ETHYL ALCOHOL CONFIRMATION
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$84.48 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.66
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$73.04
|
| Rate for Payer: First Health Commercial |
$83.60
|
| Rate for Payer: Humana Commercial |
$74.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.44
|
| Rate for Payer: Ohio Health Group HMO |
$66.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.28
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
OS ETHYL ALCOHOL CONFIRMATION
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$73.04
|
| Rate for Payer: First Health Commercial |
$83.60
|
| Rate for Payer: Humana Commercial |
$74.80
|
| 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 |
$72.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.44
|
| Rate for Payer: Ohio Health Group HMO |
$66.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.28
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
OS ETHYLENE GLYCOL S
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 82693
|
| Hospital Charge Code |
30000315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.74
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
OS ETHYLENE GLYCOL S
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 82693
|
| Hospital Charge Code |
30000315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem Medicaid |
$14.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.90
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Humana KY Medicaid |
$14.90
|
| Rate for Payer: Humana Medicare Advantage |
$14.90
|
| Rate for Payer: Kentucky WC Medicaid |
$15.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.74
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
OS ETHYL GLUCURONIDE/SULF MH
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| 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 |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
OS ETHYL GLUCURONIDE/SULF MH
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.47
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
OS EUCALYPTUS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000802
|
|
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 EUCALYPTUS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000802
|
|
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 EUROPEAN HORNET IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000782
|
|
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 EUROPEAN HORNET IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000782
|
|
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 EVEROLIMUS
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 80169
|
| Hospital Charge Code |
30000029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna Commercial |
$187.11
|
| Rate for Payer: Anthem Medicaid |
$13.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.73
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$201.69
|
| Rate for Payer: First Health Commercial |
$230.85
|
| Rate for Payer: Humana Commercial |
$206.55
|
| Rate for Payer: Humana KY Medicaid |
$13.73
|
| Rate for Payer: Humana Medicare Advantage |
$13.73
|
| Rate for Payer: Kentucky WC Medicaid |
$13.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.84
|
| Rate for Payer: Ohio Health Group HMO |
$182.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.33
|
| Rate for Payer: PHCS Commercial |
$233.28
|
| Rate for Payer: United Healthcare All Payer |
$213.84
|
|
|
OS EVEROLIMUS
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 80169
|
| Hospital Charge Code |
30000029
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.59 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna Commercial |
$187.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.13
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$201.69
|
| Rate for Payer: First Health Commercial |
$230.85
|
| Rate for Payer: Humana Commercial |
$206.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$199.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$179.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$213.84
|
| Rate for Payer: Ohio Health Group HMO |
$182.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.33
|
| Rate for Payer: PHCS Commercial |
$233.28
|
| Rate for Payer: United Healthcare All Payer |
$213.84
|
|
|
OS FACTOR INHIBITOR SCRN
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
HCPCS 85335
|
| Hospital Charge Code |
30000596
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$312.96 |
| Rate for Payer: Aetna Commercial |
$251.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.78
|
| Rate for Payer: Cash Price |
$163.00
|
| Rate for Payer: Cigna Commercial |
$270.58
|
| Rate for Payer: First Health Commercial |
$309.70
|
| Rate for Payer: Humana Commercial |
$277.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$267.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$240.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.88
|
| Rate for Payer: Ohio Health Group HMO |
$244.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.06
|
| Rate for Payer: PHCS Commercial |
$312.96
|
| Rate for Payer: United Healthcare All Payer |
$286.88
|
|
