|
OS INHIBIN
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
30001070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.88
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
OS INHIBIN
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
30001070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem Medicaid |
$15.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.59
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Humana KY Medicaid |
$15.59
|
| Rate for Payer: Humana Medicare Advantage |
$15.59
|
| Rate for Payer: Kentucky WC Medicaid |
$15.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.88
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
OS INSITU HYBRIDIZATION (FISH)
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
HCPCS 88365
|
| Hospital Charge Code |
30001858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$478.08 |
| Rate for Payer: Aetna Commercial |
$383.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.89
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$413.34
|
| Rate for Payer: First Health Commercial |
$473.10
|
| Rate for Payer: Humana Commercial |
$423.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$408.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$367.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$438.24
|
| Rate for Payer: Ohio Health Group HMO |
$373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.38
|
| Rate for Payer: PHCS Commercial |
$478.08
|
| Rate for Payer: United Healthcare All Payer |
$438.24
|
|
|
OS INSITU HYBRIDIZATION (FISH)
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
HCPCS 88365
|
| Hospital Charge Code |
30001858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$478.08 |
| Rate for Payer: Aetna Commercial |
$383.46
|
| Rate for Payer: Anthem Medicaid |
$171.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$199.40
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cash Price |
$249.00
|
| Rate for Payer: Cigna Commercial |
$413.34
|
| Rate for Payer: First Health Commercial |
$473.10
|
| Rate for Payer: Humana Commercial |
$423.30
|
| Rate for Payer: Humana KY Medicaid |
$171.26
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$173.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$408.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$367.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$438.24
|
| Rate for Payer: Ohio Health Group HMO |
$373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.38
|
| Rate for Payer: PHCS Commercial |
$478.08
|
| Rate for Payer: United Healthcare All Payer |
$438.24
|
|
|
OS INSITU HYBRIDIZ (FISH) ADD
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS 88364
|
| Hospital Charge Code |
30001879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.18 |
| Max. Negotiated Rate |
$466.56 |
| Rate for Payer: Aetna Commercial |
$374.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.26
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$403.38
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: Humana Commercial |
$413.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$398.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$358.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$427.68
|
| Rate for Payer: Ohio Health Group HMO |
$364.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.66
|
| Rate for Payer: PHCS Commercial |
$466.56
|
| Rate for Payer: United Healthcare All Payer |
$427.68
|
|
|
OS INSITU HYBRIDIZ (FISH) ADD
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS 88364
|
| Hospital Charge Code |
30001879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.18 |
| Max. Negotiated Rate |
$466.56 |
| Rate for Payer: Aetna Commercial |
$374.22
|
| Rate for Payer: Anthem Medicaid |
$167.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.26
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$403.38
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: Humana Commercial |
$413.10
|
| Rate for Payer: Humana KY Medicaid |
$167.14
|
| Rate for Payer: Kentucky WC Medicaid |
$168.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$398.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$358.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$170.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$427.68
|
| Rate for Payer: Ohio Health Group HMO |
$364.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.66
|
| Rate for Payer: PHCS Commercial |
$466.56
|
| Rate for Payer: United Healthcare All Payer |
$427.68
|
|
|
OS INSULIN ANTIBODIES
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 86337
|
| Hospital Charge Code |
30001071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.75
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
OS INSULIN ANTIBODIES
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 86337
|
| Hospital Charge Code |
30001071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem Medicaid |
$21.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.41
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Humana KY Medicaid |
$21.41
|
| Rate for Payer: Humana Medicare Advantage |
$21.41
|
| Rate for Payer: Kentucky WC Medicaid |
$21.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
OS INSULIN BEEF IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000956
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS INSULIN BEEF IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000956
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS INSULIN HUMAN IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000891
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS INSULIN HUMAN IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000891
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS INSULIN LIKE GROWTH FACT 1
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS 84305
|
| Hospital Charge Code |
30000514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.67 |
| Max. Negotiated Rate |
$344.64 |
| Rate for Payer: Aetna Commercial |
$276.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$288.28
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$297.97
|
| Rate for Payer: First Health Commercial |
$341.05
|
| Rate for Payer: Humana Commercial |
$305.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.92
|
| Rate for Payer: Ohio Health Group HMO |
$269.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.29
|
| Rate for Payer: PHCS Commercial |
$344.64
|
| Rate for Payer: United Healthcare All Payer |
$315.92
|
|
|
OS INSULIN LIKE GROWTH FACT 1
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS 84305
|
| Hospital Charge Code |
30000514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$344.64 |
| Rate for Payer: Aetna Commercial |
$276.43
|
| Rate for Payer: Anthem Medicaid |
$21.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$288.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$21.26
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cash Price |
$179.50
|
| Rate for Payer: Cigna Commercial |
$297.97
|
| Rate for Payer: First Health Commercial |
$341.05
|
| Rate for Payer: Humana Commercial |
$305.15
|
| Rate for Payer: Humana KY Medicaid |
$21.26
|
| Rate for Payer: Humana Medicare Advantage |
$21.26
|
| Rate for Payer: Kentucky WC Medicaid |
$21.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$264.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$315.92
|
| Rate for Payer: Ohio Health Group HMO |
$269.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.29
|
| Rate for Payer: PHCS Commercial |
$344.64
|
| Rate for Payer: United Healthcare All Payer |
$315.92
|
|
|
OS INSULIN PORK IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000792
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS INSULIN PORK IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000792
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS IntelliGEN Myeloid
|
Facility
|
IP
|
$4,562.00
|
|
|
Service Code
|
HCPCS 81450
|
| Hospital Charge Code |
30001898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$593.06 |
| Max. Negotiated Rate |
$4,379.52 |
| Rate for Payer: Aetna Commercial |
$3,512.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,663.29
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cigna Commercial |
$3,786.46
|
| Rate for Payer: First Health Commercial |
$4,333.90
|
| Rate for Payer: Humana Commercial |
$3,877.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,740.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,366.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,014.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.22
|
| Rate for Payer: PHCS Commercial |
$4,379.52
|
| Rate for Payer: United Healthcare All Payer |
$4,014.56
|
|
|
OS IntelliGEN Myeloid
|
Facility
|
OP
|
$4,562.00
|
|
|
Service Code
|
HCPCS 81450
|
| Hospital Charge Code |
30001898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$593.06 |
| Max. Negotiated Rate |
$4,379.52 |
| Rate for Payer: Aetna Commercial |
$3,512.74
|
| Rate for Payer: Anthem Medicaid |
$759.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$759.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,663.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,063.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.53
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cigna Commercial |
$3,786.46
|
| Rate for Payer: First Health Commercial |
$4,333.90
|
| Rate for Payer: Humana Commercial |
$3,877.70
|
| Rate for Payer: Humana KY Medicaid |
$759.53
|
| Rate for Payer: Humana Medicare Advantage |
$759.53
|
| Rate for Payer: Kentucky WC Medicaid |
$767.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,740.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,366.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,014.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.22
|
| Rate for Payer: PHCS Commercial |
$4,379.52
|
| Rate for Payer: United Healthcare All Payer |
$4,014.56
|
|
|
OS INTERLEUKIN 1B
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000402
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.37 |
| Max. Negotiated Rate |
$431.04 |
| Rate for Payer: Aetna Commercial |
$345.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.55
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cigna Commercial |
$372.67
|
| Rate for Payer: First Health Commercial |
$426.55
|
| Rate for Payer: Humana Commercial |
$381.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$395.12
|
| Rate for Payer: Ohio Health Group HMO |
$336.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.19
|
| Rate for Payer: PHCS Commercial |
$431.04
|
| Rate for Payer: United Healthcare All Payer |
$395.12
|
|
|
OS INTERLEUKIN 1B
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30000402
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$431.04 |
| Rate for Payer: Aetna Commercial |
$345.73
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cigna Commercial |
$372.67
|
| Rate for Payer: First Health Commercial |
$426.55
|
| Rate for Payer: Humana Commercial |
$381.65
|
| 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 |
$368.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$395.12
|
| Rate for Payer: Ohio Health Group HMO |
$336.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.19
|
| Rate for Payer: PHCS Commercial |
$431.04
|
| Rate for Payer: United Healthcare All Payer |
$395.12
|
|
|
OS INTERLEUKIN 6
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 83529
|
| Hospital Charge Code |
30000420
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$150.72 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| 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 |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.67
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
OS INTERLEUKIN 6
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 83529
|
| Hospital Charge Code |
30000420
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$150.72 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.07
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.67
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
OS INTERPHAS INSIT HYBRDZAT 1
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.71
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
OS INTERPHAS INSIT HYBRDZAT 1
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$51.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.19
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Humana KY Medicaid |
$51.19
|
| Rate for Payer: Humana Medicare Advantage |
$51.19
|
| Rate for Payer: Kentucky WC Medicaid |
$51.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
OS INTERPHAS INSIT HYBRDZAT 2
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
30001499
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.97 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.71
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.39
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
