|
OS IMMUNOELECTROPHORESIS URINE
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 86325
|
| Hospital Charge Code |
30001067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.21
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.16
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
OS IMMUNOFIXATION CSF/URINE
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
30001069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$29.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.35
|
| 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 |
$29.35
|
| Rate for Payer: Humana Medicare Advantage |
$29.35
|
| Rate for Payer: Kentucky WC Medicaid |
$29.64
|
| 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 |
$35.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.94
|
| 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 |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
OS IMMUNOFIXATION CSF/URINE
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
30001069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.51 |
| 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 |
$45.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.37
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
OS IMMUNOFIXATION SERUM
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
30001068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.59 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: Aetna Commercial |
$264.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$275.43
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$284.69
|
| Rate for Payer: First Health Commercial |
$325.85
|
| Rate for Payer: Humana Commercial |
$291.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$281.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$253.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$301.84
|
| Rate for Payer: Ohio Health Group HMO |
$257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.33
|
| Rate for Payer: PHCS Commercial |
$329.28
|
| Rate for Payer: United Healthcare All Payer |
$301.84
|
|
|
OS IMMUNOFIXATION SERUM
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
30001068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: Aetna Commercial |
$264.11
|
| Rate for Payer: Anthem Medicaid |
$22.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$275.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.34
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$284.69
|
| Rate for Payer: First Health Commercial |
$325.85
|
| Rate for Payer: Humana Commercial |
$291.55
|
| Rate for Payer: Humana KY Medicaid |
$22.34
|
| Rate for Payer: Humana Medicare Advantage |
$22.34
|
| Rate for Payer: Kentucky WC Medicaid |
$22.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$281.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$253.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$301.84
|
| Rate for Payer: Ohio Health Group HMO |
$257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.33
|
| Rate for Payer: PHCS Commercial |
$329.28
|
| Rate for Payer: United Healthcare All Payer |
$301.84
|
|
|
OS IMMUNOFLUOR ANTB ADDL STAIN
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 88350
|
| Hospital Charge Code |
30001837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem Medicaid |
$14.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Humana KY Medicaid |
$14.44
|
| Rate for Payer: Kentucky WC Medicaid |
$14.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
OS IMMUNOFLUOR ANTB ADDL STAIN
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 88350
|
| Hospital Charge Code |
30001837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.73
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$34.86
|
| Rate for Payer: First Health Commercial |
$39.90
|
| Rate for Payer: Humana Commercial |
$35.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.96
|
| Rate for Payer: Ohio Health Group HMO |
$31.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.02
|
| Rate for Payer: PHCS Commercial |
$40.32
|
| Rate for Payer: United Healthcare All Payer |
$36.96
|
|
|
OS IMMUNOGLOBULIN E (IGE)
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
30000325
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13.65
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cigna Commercial |
$14.11
|
| Rate for Payer: First Health Commercial |
$16.15
|
| Rate for Payer: Humana Commercial |
$14.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.96
|
| Rate for Payer: Ohio Health Group HMO |
$12.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.27
|
| Rate for Payer: PHCS Commercial |
$16.32
|
| Rate for Payer: United Healthcare All Payer |
$14.96
|
|
|
OS IMMUNOGLOBULIN E (IGE)
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
30000325
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$23.04 |
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Anthem Medicaid |
$16.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.46
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cigna Commercial |
$14.11
|
| Rate for Payer: First Health Commercial |
$16.15
|
| Rate for Payer: Humana Commercial |
$14.45
|
| Rate for Payer: Humana KY Medicaid |
$16.46
|
| Rate for Payer: Humana Medicare Advantage |
$16.46
|
| Rate for Payer: Kentucky WC Medicaid |
$16.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.96
|
| Rate for Payer: Ohio Health Group HMO |
$12.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.27
|
| Rate for Payer: PHCS Commercial |
$16.32
|
| Rate for Payer: United Healthcare All Payer |
$14.96
|
|
|
OS IMMUNOHISTOCHEM 1ST
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
30001526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.03 |
| Max. Negotiated Rate |
$413.76 |
| Rate for Payer: Aetna Commercial |
$331.87
|
| Rate for Payer: Anthem Medicaid |
$148.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$346.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$199.40
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$357.73
|
| Rate for Payer: First Health Commercial |
$409.45
|
| Rate for Payer: Humana Commercial |
$366.35
|
| Rate for Payer: Humana KY Medicaid |
$148.22
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$149.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$379.28
|
| Rate for Payer: Ohio Health Group HMO |
$323.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.61
|
| Rate for Payer: PHCS Commercial |
$413.76
|
| Rate for Payer: United Healthcare All Payer |
$379.28
|
|
|
OS IMMUNOHISTOCHEM 1ST
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
30001526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.03 |
| Max. Negotiated Rate |
$413.76 |
| Rate for Payer: Aetna Commercial |
$331.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$346.09
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$357.73
|
| Rate for Payer: First Health Commercial |
$409.45
|
| Rate for Payer: Humana Commercial |
$366.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$379.28
|
| Rate for Payer: Ohio Health Group HMO |
$323.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.61
|
| Rate for Payer: PHCS Commercial |
$413.76
|
| Rate for Payer: United Healthcare All Payer |
$379.28
|
|
|
OS IMMUNOHISTOCHEM EA ANTIB
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
HCPCS 88361
|
| Hospital Charge Code |
30001533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.09 |
| Max. Negotiated Rate |
$569.28 |
| Rate for Payer: Aetna Commercial |
$456.61
|
| Rate for Payer: Anthem Medicaid |
$203.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$310.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$435.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$419.62
|
| Rate for Payer: Cash Price |
$296.50
|
| Rate for Payer: Cash Price |
$296.50
|
| Rate for Payer: Cigna Commercial |
$492.19
|
| Rate for Payer: First Health Commercial |
$563.35
|
| Rate for Payer: Humana Commercial |
$504.05
|
| Rate for Payer: Humana KY Medicaid |
$203.93
|
| Rate for Payer: Humana Medicare Advantage |
$310.83
|
| Rate for Payer: Kentucky WC Medicaid |
$206.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$486.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$437.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$521.84
|
| Rate for Payer: Ohio Health Group HMO |
$444.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.83
|
| Rate for Payer: PHCS Commercial |
$569.28
|
| Rate for Payer: United Healthcare All Payer |
$521.84
|
|
|
OS IMMUNOHISTOCHEM EA ANTIB
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
HCPCS 88361
|
| Hospital Charge Code |
30001533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.09 |
| Max. Negotiated Rate |
$569.28 |
| Rate for Payer: Aetna Commercial |
$456.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.18
|
| Rate for Payer: Cash Price |
$296.50
|
| Rate for Payer: Cigna Commercial |
$492.19
|
| Rate for Payer: First Health Commercial |
$563.35
|
| Rate for Payer: Humana Commercial |
$504.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$486.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$437.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$521.84
|
| Rate for Payer: Ohio Health Group HMO |
$444.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.83
|
| Rate for Payer: PHCS Commercial |
$569.28
|
| Rate for Payer: United Healthcare All Payer |
$521.84
|
|
|
OS IMMUNOSTAIN EACH ADDITIONAL
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
30001523
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.03 |
| Max. Negotiated Rate |
$413.76 |
| Rate for Payer: Aetna Commercial |
$331.87
|
| Rate for Payer: Anthem Medicaid |
$148.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$346.09
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$357.73
|
| Rate for Payer: First Health Commercial |
$409.45
|
| Rate for Payer: Humana Commercial |
$366.35
|
| Rate for Payer: Humana KY Medicaid |
$148.22
|
| Rate for Payer: Kentucky WC Medicaid |
$149.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$379.28
|
| Rate for Payer: Ohio Health Group HMO |
$323.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.61
|
| Rate for Payer: PHCS Commercial |
$413.76
|
| Rate for Payer: United Healthcare All Payer |
$379.28
|
|
|
OS IMMUNOSTAIN EACH ADDITIONAL
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
30001523
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.03 |
| Max. Negotiated Rate |
$413.76 |
| Rate for Payer: Aetna Commercial |
$331.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$346.09
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$357.73
|
| Rate for Payer: First Health Commercial |
$409.45
|
| Rate for Payer: Humana Commercial |
$366.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$379.28
|
| Rate for Payer: Ohio Health Group HMO |
$323.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.61
|
| Rate for Payer: PHCS Commercial |
$413.76
|
| Rate for Payer: United Healthcare All Payer |
$379.28
|
|
|
OS INFLIXIMAB
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 80230
|
| Hospital Charge Code |
30001853
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$307.20 |
| Rate for Payer: Aetna Commercial |
$246.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$256.96
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$265.60
|
| Rate for Payer: First Health Commercial |
$304.00
|
| Rate for Payer: Humana Commercial |
$272.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$262.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.60
|
| Rate for Payer: Ohio Health Group HMO |
$240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.20
|
| Rate for Payer: PHCS Commercial |
$307.20
|
| Rate for Payer: United Healthcare All Payer |
$281.60
|
|
|
OS INFLIXIMAB
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 80230
|
| Hospital Charge Code |
30001853
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$307.20 |
| Rate for Payer: Aetna Commercial |
$246.40
|
| Rate for Payer: Anthem Medicaid |
$38.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$256.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.57
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$265.60
|
| Rate for Payer: First Health Commercial |
$304.00
|
| Rate for Payer: Humana Commercial |
$272.00
|
| 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 |
$262.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.60
|
| Rate for Payer: Ohio Health Group HMO |
$240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.20
|
| Rate for Payer: PHCS Commercial |
$307.20
|
| Rate for Payer: United Healthcare All Payer |
$281.60
|
|
|
OS INFLUENZA VIR A AB IGG
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$13.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.55
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$13.55
|
| Rate for Payer: Humana Medicare Advantage |
$13.55
|
| Rate for Payer: Kentucky WC Medicaid |
$13.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIR A AB IGG
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIR B AB IGG
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001188
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$13.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.55
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$13.55
|
| Rate for Payer: Humana Medicare Advantage |
$13.55
|
| Rate for Payer: Kentucky WC Medicaid |
$13.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIR B AB IGG
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001188
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIRU A ANTIB IGM
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIRU A ANTIB IGM
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001191
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$13.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.55
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$13.55
|
| Rate for Payer: Humana Medicare Advantage |
$13.55
|
| Rate for Payer: Kentucky WC Medicaid |
$13.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIRU B ANTIB IGM
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001189
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$13.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.55
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$13.55
|
| Rate for Payer: Humana Medicare Advantage |
$13.55
|
| Rate for Payer: Kentucky WC Medicaid |
$13.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
OS INFLUENZA VIRU B ANTIB IGM
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 86710
|
| Hospital Charge Code |
30001189
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.95
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
