|
OS ACAA AB
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem Medicaid |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Humana KY Medicaid |
$11.53
|
| Rate for Payer: Humana Medicare Advantage |
$11.53
|
| Rate for Payer: Kentucky WC Medicaid |
$11.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.19
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
OS ACAA AB
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.19
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
OS ACACIA IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS ACACIA IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS ACETAMINOPHEN CONFIRMATION
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.55
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
OS ACETAMINOPHEN CONFIRMATION
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 80329
|
| Hospital Charge Code |
30000086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.55
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
OS ACETAMINOPHEN CONFIRMATION
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| 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 |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.55
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
OS ACETAMINOPHEN CONFIRMATION
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 80329
|
| Hospital Charge Code |
30000086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem Medicaid |
$32.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.28
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Humana KY Medicaid |
$32.67
|
| Rate for Payer: Kentucky WC Medicaid |
$33.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.55
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
OS ACETYCHOLINE MODULAT ANTBOD
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 86043
|
| Hospital Charge Code |
30000393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.19
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
OS ACETYCHOLINE MODULAT ANTBOD
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 86043
|
| Hospital Charge Code |
30000393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.19
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
OS ACETYLCHOLINESTERASE AF
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 82013
|
| Hospital Charge Code |
30000221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$12.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.29
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Humana KY Medicaid |
$12.29
|
| Rate for Payer: Humana Medicare Advantage |
$12.29
|
| Rate for Payer: Kentucky WC Medicaid |
$12.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
OS ACETYLCHOLINESTERASE AF
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 82013
|
| Hospital Charge Code |
30000221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.99
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
OS ACETYLCHOLINESTRASE RBC
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 82482
|
| Hospital Charge Code |
30000283
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$9.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.81
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Humana KY Medicaid |
$9.81
|
| Rate for Payer: Humana Medicare Advantage |
$9.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OS ACETYLCHOLINESTRASE RBC
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 82482
|
| Hospital Charge Code |
30000283
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.42
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
OS ACH Binding/Modulating AB
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
30000391
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$229.44 |
| Rate for Payer: Aetna Commercial |
$184.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.92
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$198.37
|
| Rate for Payer: First Health Commercial |
$227.05
|
| Rate for Payer: Humana Commercial |
$203.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$195.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$176.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$210.32
|
| Rate for Payer: Ohio Health Group HMO |
$179.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.91
|
| Rate for Payer: PHCS Commercial |
$229.44
|
| Rate for Payer: United Healthcare All Payer |
$210.32
|
|
|
OS ACH Binding/Modulating AB
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
30000391
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$229.44 |
| Rate for Payer: Aetna Commercial |
$184.03
|
| Rate for Payer: Anthem Medicaid |
$18.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.40
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cash Price |
$119.50
|
| Rate for Payer: Cigna Commercial |
$198.37
|
| Rate for Payer: First Health Commercial |
$227.05
|
| Rate for Payer: Humana Commercial |
$203.15
|
| Rate for Payer: Humana KY Medicaid |
$18.40
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Kentucky WC Medicaid |
$18.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$195.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$176.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$210.32
|
| Rate for Payer: Ohio Health Group HMO |
$179.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.91
|
| Rate for Payer: PHCS Commercial |
$229.44
|
| Rate for Payer: United Healthcare All Payer |
$210.32
|
|
|
OS ACh RECEPTOR (MUSCLE) BIND
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 86041
|
| Hospital Charge Code |
30000395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem Medicaid |
$18.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.40
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Humana KY Medicaid |
$18.40
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Kentucky WC Medicaid |
$18.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.19
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
OS ACh RECEPTOR (MUSCLE) BIND
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 86041
|
| Hospital Charge Code |
30000395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Aetna Commercial |
$193.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$201.55
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cigna Commercial |
$208.33
|
| Rate for Payer: First Health Commercial |
$238.45
|
| Rate for Payer: Humana Commercial |
$213.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.88
|
| Rate for Payer: Ohio Health Group HMO |
$188.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.19
|
| Rate for Payer: PHCS Commercial |
$240.96
|
| Rate for Payer: United Healthcare All Payer |
$220.88
|
|
|
OS ACHR GANCLONIC NEURONAL AB
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
30000386
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.10 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
OS ACHR GANCLONIC NEURONAL AB
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
30000386
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$18.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.40
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$18.40
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Kentucky WC Medicaid |
$18.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
OS ACTINOMYCES ANTIBODY
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 86602
|
| Hospital Charge Code |
30001996
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.07
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.25
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
OS ACTINOMYCES ANTIBODY
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 86602
|
| Hospital Charge Code |
30001996
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem Medicaid |
$10.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.18
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Humana KY Medicaid |
$10.18
|
| Rate for Payer: Humana Medicare Advantage |
$10.18
|
| Rate for Payer: Kentucky WC Medicaid |
$10.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.25
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
OS ACTIVATED PTT
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
30000631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Aetna Commercial |
$194.04
|
| Rate for Payer: Anthem Medicaid |
$6.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.01
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$209.16
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Humana Commercial |
$214.20
|
| Rate for Payer: Humana KY Medicaid |
$6.01
|
| Rate for Payer: Humana Medicare Advantage |
$6.01
|
| Rate for Payer: Kentucky WC Medicaid |
$6.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.76
|
| Rate for Payer: Ohio Health Group HMO |
$189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.88
|
| Rate for Payer: PHCS Commercial |
$241.92
|
| Rate for Payer: United Healthcare All Payer |
$221.76
|
|
|
OS ACTIVATED PTT
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
30000631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Aetna Commercial |
$194.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.36
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$209.16
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Humana Commercial |
$214.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.76
|
| Rate for Payer: Ohio Health Group HMO |
$189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.88
|
| Rate for Payer: PHCS Commercial |
$241.92
|
| Rate for Payer: United Healthcare All Payer |
$221.76
|
|
|
OS ACTIV PROTEIN C RESIST V P
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
HCPCS 85307
|
| Hospital Charge Code |
30000595
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$423.36 |
| Rate for Payer: Aetna Commercial |
$339.57
|
| Rate for Payer: Anthem Medicaid |
$15.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.32
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$366.03
|
| Rate for Payer: First Health Commercial |
$418.95
|
| Rate for Payer: Humana Commercial |
$374.85
|
| Rate for Payer: Humana KY Medicaid |
$15.32
|
| Rate for Payer: Humana Medicare Advantage |
$15.32
|
| Rate for Payer: Kentucky WC Medicaid |
$15.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$361.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$325.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$388.08
|
| Rate for Payer: Ohio Health Group HMO |
$330.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$383.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$304.29
|
| Rate for Payer: PHCS Commercial |
$423.36
|
| Rate for Payer: United Healthcare All Payer |
$388.08
|
|
