|
OS ACTIV PROTEIN C RESIST V P
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
HCPCS 85307
|
| Hospital Charge Code |
30000595
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$423.36 |
| Rate for Payer: Aetna Commercial |
$339.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.12
|
| 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: 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 |
$132.30
|
| 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
|
|
|
OS ACYLCARNITINE QUANT P
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 82017
|
| Hospital Charge Code |
30000222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.23
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
OS ACYLCARNITINE QUANT P
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 82017
|
| Hospital Charge Code |
30000222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem Medicaid |
$16.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.87
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Humana KY Medicaid |
$16.87
|
| Rate for Payer: Humana Medicare Advantage |
$16.87
|
| Rate for Payer: Kentucky WC Medicaid |
$17.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
OS ADALIMUMAB
|
Facility
|
IP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 80145
|
| Hospital Charge Code |
30001954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$539.10 |
| Max. Negotiated Rate |
$1,725.12 |
| Rate for Payer: Aetna Commercial |
$1,383.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,442.99
|
| Rate for Payer: Cash Price |
$898.50
|
| Rate for Payer: Cigna Commercial |
$1,491.51
|
| Rate for Payer: First Health Commercial |
$1,707.15
|
| Rate for Payer: Humana Commercial |
$1,527.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,473.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,581.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,347.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,563.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.93
|
| Rate for Payer: PHCS Commercial |
$1,725.12
|
| Rate for Payer: United Healthcare All Payer |
$1,581.36
|
|
|
OS ADALIMUMAB
|
Facility
|
OP
|
$1,797.00
|
|
|
Service Code
|
HCPCS 80145
|
| Hospital Charge Code |
30001954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$1,725.12 |
| Rate for Payer: Aetna Commercial |
$1,383.69
|
| Rate for Payer: Anthem Medicaid |
$38.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,442.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.57
|
| Rate for Payer: Cash Price |
$898.50
|
| Rate for Payer: Cash Price |
$898.50
|
| Rate for Payer: Cigna Commercial |
$1,491.51
|
| Rate for Payer: First Health Commercial |
$1,707.15
|
| Rate for Payer: Humana Commercial |
$1,527.45
|
| Rate for Payer: Humana KY Medicaid |
$38.57
|
| Rate for Payer: Humana Medicare Advantage |
$38.57
|
| Rate for Payer: Kentucky WC Medicaid |
$38.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,473.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,581.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,347.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,563.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.93
|
| Rate for Payer: PHCS Commercial |
$1,725.12
|
| Rate for Payer: United Healthcare All Payer |
$1,581.36
|
|
|
OS AGNA,AMPA,DPPX,GABA,mGluR1
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| 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 |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS AGNA,AMPA,DPPX,GABA,mGluR1
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
30001030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
OS ALBUMIN FLUID
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
30000226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Anthem Medicaid |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.78
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: First Health Commercial |
$203.30
|
| Rate for Payer: Humana Commercial |
$181.90
|
| Rate for Payer: Humana KY Medicaid |
$7.78
|
| Rate for Payer: Humana Medicare Advantage |
$7.78
|
| Rate for Payer: Kentucky WC Medicaid |
$7.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$188.32
|
| Rate for Payer: Ohio Health Group HMO |
$160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$186.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.66
|
| Rate for Payer: PHCS Commercial |
$205.44
|
| Rate for Payer: United Healthcare All Payer |
$188.32
|
|
|
OS ALBUMIN FLUID
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
30000226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.84
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: First Health Commercial |
$203.30
|
| Rate for Payer: Humana Commercial |
$181.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$188.32
|
| Rate for Payer: Ohio Health Group HMO |
$160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$186.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.66
|
| Rate for Payer: PHCS Commercial |
$205.44
|
| Rate for Payer: United Healthcare All Payer |
$188.32
|
|
|
OS ALBUMIN SERUM
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
30000224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem Medicaid |
$4.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$172.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.95
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Humana KY Medicaid |
$4.95
|
| Rate for Payer: Humana Medicare Advantage |
$4.95
|
| Rate for Payer: Kentucky WC Medicaid |
$5.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.35
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
OS ALBUMIN SERUM
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
30000224
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$172.65
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.35
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
OS ALCA AB
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000378
|
|
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 ALCA AB
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
30000378
|
|
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 ALCOHOL
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS 82077
|
| Hospital Charge Code |
30000073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$169.92 |
| Rate for Payer: Aetna Commercial |
$136.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.13
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cigna Commercial |
$146.91
|
| Rate for Payer: First Health Commercial |
$168.15
|
| Rate for Payer: Humana Commercial |
$150.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$130.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$155.76
|
| Rate for Payer: Ohio Health Group HMO |
$132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.13
|
| Rate for Payer: PHCS Commercial |
$169.92
|
| Rate for Payer: United Healthcare All Payer |
$155.76
|
|
|
OS ALCOHOL
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS 82077
|
| Hospital Charge Code |
30000073
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$169.92 |
| Rate for Payer: Aetna Commercial |
$136.29
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cash Price |
$88.50
|
| Rate for Payer: Cigna Commercial |
$146.91
|
| Rate for Payer: First Health Commercial |
$168.15
|
| Rate for Payer: Humana Commercial |
$150.45
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$145.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$130.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$155.76
|
| Rate for Payer: Ohio Health Group HMO |
$132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.13
|
| Rate for Payer: PHCS Commercial |
$169.92
|
| Rate for Payer: United Healthcare All Payer |
$155.76
|
|
|
OS ALCOHOL URINE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.39 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna Commercial |
$23.87
|
| Rate for Payer: Anthem Medicaid |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$87.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$62.14
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna Commercial |
$25.73
|
| Rate for Payer: First Health Commercial |
$29.45
|
| Rate for Payer: Humana Commercial |
$26.35
|
| Rate for Payer: Humana KY Medicaid |
$62.14
|
| Rate for Payer: Humana Medicare Advantage |
$62.14
|
| Rate for Payer: Kentucky WC Medicaid |
$62.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.28
|
| Rate for Payer: Ohio Health Group HMO |
$23.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$29.76
|
| Rate for Payer: United Healthcare All Payer |
$27.28
|
|
|
OS ALCOHOL URINE
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Ambetter Exchange |
$62.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$62.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$62.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.57
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna Commercial |
$53.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.14
|
| Rate for Payer: Multiplan PHCS |
$18.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.78
|
| Rate for Payer: UHCCP Medicaid |
$10.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$62.14
|
|
|
OS ALCOHOL URINE
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
30000067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna Commercial |
$23.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.89
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna Commercial |
$25.73
|
| Rate for Payer: First Health Commercial |
$29.45
|
| Rate for Payer: Humana Commercial |
$26.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.28
|
| Rate for Payer: Ohio Health Group HMO |
$23.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$29.76
|
| Rate for Payer: United Healthcare All Payer |
$27.28
|
|
|
OS ALDOLASE SERUM
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 82085
|
| Hospital Charge Code |
30000229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.52
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS ALDOLASE SERUM
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 82085
|
| Hospital Charge Code |
30000229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem Medicaid |
$9.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.71
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Humana KY Medicaid |
$9.71
|
| Rate for Payer: Humana Medicare Advantage |
$9.71
|
| Rate for Payer: Kentucky WC Medicaid |
$9.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.52
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
OS ALDOSTERONE
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
HCPCS 82088
|
| Hospital Charge Code |
30000230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$356.16 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.91
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.99
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
|
OS ALDOSTERONE
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
HCPCS 82088
|
| Hospital Charge Code |
30000230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$356.16 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem Medicaid |
$40.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$40.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.75
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Humana KY Medicaid |
$40.75
|
| Rate for Payer: Humana Medicare Advantage |
$40.75
|
| Rate for Payer: Kentucky WC Medicaid |
$41.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.99
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
|
OS ALLERGEN, IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000908
|
|
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 ALLERGEN, IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000908
|
|
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 ALLERGEN IGE CHOCOL COCOA
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000669
|
|
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
|
|
